Page numbers printed in boldface type refer to tables or figures.
Adolescents, and adolescenceadversities and sexual desire deficiencies in,57
lifelong erectile dysfunction and,39
prevalence of transgender identity in,86
rapid ejaculation and,14
masturbation and,24–25
Advocacy, and gender revolution,93
“Aesthetic gynecologists,”114
Age, of therapist and understanding of sexual desire,50.
See also Adolescents; Life cycle
Alcohol use, and flibanserin,54.
See also Substance abuse
Ambition, and love,100
Ambivalence, and genito-pelvic pain/penetration disorder,118
American Academy of Pediatrics,88
American Psychiatric Association,88
American Psychological Association,88
Anorgasmiacase examples of,25, 30–31
consequences of untreated,23–24
masturbation and,24–26
partner relationship and,30–31
prevalence of,23
treatment of,26–29
varieties of,21–22
Arousal, and erectile dysfunction,34–35
Attachment, and love,101
Autismgender dysphoria and,89
problematic sexual function and,114–115
Autonomy, gender dysphoria and respect for patient’s,93
Avanafil,43
Best interest of patient, as ethical standard,92, 93
Betrayals, in relationshipscase examples of,71–72, 74–77
dark triad and,77–79
descriptions of in literature,129
as example of dilemma,124
grief and,68
love affairs and,72–77
sexual addiction and,68–72
therapist’s role and reactions to,64–68
Biological sexas aspect of identity,83
as component of sexual desire,49–50, 51
organization of thought about sexual problems and,9
Bipolar disorder, and sexual desire,56
Body imageidentity and,83
problems with sexual desire and,55
Bond, and love as an attachment,101
Boundary violations, and natural voyeuristic response,3
Bremelanotide,54
Burnout, of mental health professionals,128
Cancer, and sexual desire,55
Case examplesof anorgasmia,25, 30–31
of care for older patients,132–133
of erectile dysfunction,37, 38–39, 40, 41, 43
of genito-pelvic pain/penetration disorder,119, 120
of love affairs,74–77
of paraphilias,106, 108–109, 109–111
of sexual addiction,71–72
of sexual desire in women,53, 56, 57
Character traitspathology of and betrayals,77–78
personal identity and,83
Chemotherapy, and sexual desire,55, 59
Childhood adversities, and acquired or lifelong forms of desire deficiencies,57–59
Circular model, of sexual desire,52–53
Cis gendered,86, 87
Clinical science, and professional development,129–130
Clinicians.
See Mental health professionals
Clomipramine,16–17
Coming-out process, and sexual identity,96
Commercial sex, business of,68–69.
See also Pornography
Comorbidity, of sexual problems with mental disordersgender dysphoria and,90
lifelong erectile dysfunction and,39
Countertransference, and reactions to betrayal,64–65, 73
Culturearranged marriages and,100
attitudes toward basic feelings,102
expectations for male and female roles,14
influence of on sexual life,6
masturbation and,24
Deal, love as,100
Deaths, and sexual masochistic disorder,108
Delayed ejaculation, psychotherapy and treatment of,19
Depression, and loss of sexual desire,56.
See also Psychotic depression
Desire, use of term in sexual dysfunction nosology,53.
See also Sexual desire
Diagnosis, of gender dysphoria,88–90.
See also Evaluation
Disorder.
See also Bipolar disorder; Mental illness; Obsessive-compulsive disorder
boundaries between range of normal experience and,12
history of psychiatry and definition of,81–82
Dissociation, and gender dysphoria,89
Distress, and betrayals,65–66
DSM-IV, and disorders related to sexual desire and arousal,53
DSM-5definition of erectile disorder and,34
female sexual interest/arousal disorder in,53
gender dysphoria in,88–89
genito-pelvic pain/penetration disorder in,116
multifactorial etiology of disorders in,10
paraphilic disorders listed in,105–109
sexual function and male/female disorders in,5
Dyspareuniamedical evaluation of,115, 116
menopause and,60
prevalence and hidden pattern of,117
Eating disorders,89
Economic status, as aspect of identity,83
Emotionsinterpersonal regulation model and complexity of sexual dysfunctions,117
love as transient state of,102
response to betrayal and,65–66
Erectile dysfunctionsacquired forms of,37–38
in adolescents,39
case examples of,37, 38–39, 40, 41, 43
definition of erectile disorder in DSM-5,34
disconnection between emotional self-awareness and conduct of sex,33
lifelong forms of,38–39, 41–42
major conceptual pathways on,34–35
prognosis for,42–43
range of therapies for,43–45
referrals for medical evaluation,35–37
sexual desire and,59
suggestions for self-help strategies,40–42
therapeutic alliance and psychotherapy for,45–47
Eroticismlimitations of clinical work and,4
sexual behaviors as distinct from,2–3
Estrogen and estradiol, and hormone replacement therapy,60
Ethicsgender dysphoria and,92–93
natural voyeuristic response and,3
Etiology, use of term in context,10
Evaluation, of patient with gender dysphoria,90–91.
See also Diagnosis
Excitement, and erectile dysfunction,40, 41
Family, and evaluation of gender dysphoria,91
Fantasieserectile dysfunction and,40–41
gender of therapist and,29
social isolation and,70
Fear, and erectile dysfunction,40, 41, 43
Feeling, as distinct from emotion,102
Female sexual arousal disorder,53
Female sexual interest/arousal disorder,53, 54, 59
Feminism, and normalization of masturbation for women,26
Femininity, wide variations in definition of,85, 86, 87
Flibanserin,11, 53–54
Food and Drug Administration,45, 53
Food restrictions, and PDE-5 inhibitors,43
Force of nature, love as,101–102
Forensic settings, and paraphilias,105.
See also Prisons
Freud, Sigmund,4
Gender.
See also Gender dysphoria; Gender identity
cultural expectations for roles,14
sexual addiction and,70–71
sexual desire issues and,59
sexual function disorders in DSM-5 and,5
of therapist and treatment of anorgasmia,29
Gender binary,86, 87
Gender dimorphism,86
Gender dysphoria, diagnosis of,88–90
Gender identity.
See also Identity
as component of sexual identity,5, 85
controversy on,93–94
as example of dilemma,124
gender incongruence and,85–94
of therapist and discussions about rapid ejaculation,18–19
Gender variant, use of term,86, 87
Generalized anorgasmia,22
Genito-pelvic pain/penetration disordercase examples of,119, 120
DSM-5 and,116
lack of coordination in treatment of,116–117
mental illness and,119–121
suggestions for treatment of,118–119
Grief, and betrayal,68
Group therapymasturbation and,26
paraphilias and,109
for sex offenders,67–68
Guidelines, for initial response to patients,12
Guilt, and betrayals,67
Health care.
See also Medical conditions
dyspareunia and,115, 116
needs of trans people and,92
referrals of erectile dysfunction for evaluation,35–37
risks of gender reassignment,91
HIV, and gender dysphoria,90
Homophobia, residual internalized forms of,96
Homosexuality, transition in view of,81.
See also LGBTIQA community
Hormone replacement therapy (HRT),55, 60
Human Sexual Inadequacy (Masters and Johnson 1970),63
Hypersexual disorder,70
Hypoactive sexual desire disorder,53, 54, 59
Hypochondriasis,117
Identity.
See also Gender identity; Sexual identity
definition and aspects of,82–84
love as attachment and,101
Illusion, love as,102–103
Individual therapy, for erectile dysfunction,47
Infidelity.
See also Betrayals
Information resources, on sexual dysfunctions and sexuality,135–136
Informed consent, and risks of gender reassignment,91–92
Intention, and sexual identity,85
Internetchanging views of transgender individuals and,87
information resources and,136
Interpersonal emotion regulation model,117
In vitro fertilization (IVF),124
Job satisfaction, and professional development,128
Johnson, V.,4, 16, 63
Journals, on sexuality,135
LGBTIQA community.
See also Sexual minority community
history of oppression,81
sexual addiction and clinics for,69
Life cyclebiological component of sexual desire and,49, 51
continual changes in sexual life and,9
mental health professionals and focus on,132
Lifelong psychogenic erectile dysfunction,38–39, 41–42
Linear model, of sexual desire,52–53
Literature, descriptions of infidelity in,129.
See also Information resources
Lovecommonalities of psychotherapy and,127–128
definition of aspects of,99, 100–105
paraphilias and,105–107, 109–111
Love affairs, and betrayals,72–77
Love object, and commercial sex,70
Managementbetrayals and preoccupation with issues of,67
love as process of,101
Marriage.
See also Betrayals; Partner relationships
culture and arranged forms of,100
as moral commitment,101
Supreme Court ruling on equality and antidiscrimination,87
Masculinity, wide variations in definition of,85, 86, 87
Masters, W.H.,4, 16, 63
Masturbationanorgasmia and,24–26
erectile dysfunction and,42
Maturation, as goal of psychotherapy,119
Mead, Margaret,33
Media, and changing views on gender identity,87
Medical conditions.
See also Cancer; Health care; Multiple sclerosis; Myocardial infarction
gender dysphoria and,90
personal identity and,84
sexual desire and,55
Medications.
See also Pharmacotherapy
Menopause, and sexual desire,50, 59–61
Mental health professionals.
See also Boundary violations; Psychotherapy
age of and understanding of sexual desire,50
characteristics of and patient’s comfort with discussing eroticism and sexual behaviors,2–3
commonalities of psychotherapy and love,127–128
discussions about rapid ejaculation and,18–19
emphasis on professional development of,130–133
eroticism and limits of clinical work,4
gender dysphoria and roles of,90–91
gender and sexual identity of,18–19, 94–96
guidelines for initial response to patients,12
helping patient live better life as goal of,125–126
impacts of working with sexual dysfunctions on,7–8
making distinctions in care of patients,123–125
natural voyeuristic response and,3
questions about knowledge on sexual life,6
reactions of to betrayals,64–68
respect for patient’s privacy in discussions of sexual life,1–2
role satisfaction and professional development of,128
role of in treatment of anorgasmia,28–29
Mental illness.
See also Bipolar disorder; Comorbidity; Depression; Disorder; Obsessive-compulsive disorder
genito-pelvic pain/penetration disorder and,119–121
risks of gender reassignment and,92
Mindfulness, as therapeutic approach,130
Morality, and love as commitment,101.
See also Values
Motivationcommercial sex as distinct from love affair,69
factors in willingness to engage in sexual behavior,51
sexual desire in women and,54, 56
Multiple sclerosis,18
Myocardial infarction,18
Naloxone,109
Narcissism, and dark triad of betrayal,78
National Institutes of Health,34
Neurobiology, childhood adversities and changes in,57
Obesity, and sexual desire,55
Obsessive-compulsive disorder (OCD), and genito-pelvic pain/penetration disorder,120, 121
Oophorectomy, and sexual desire,59
Organizations, and information resources,136
Orgasm, definition and importance of,23–24.
See also Anorgasmia; Masturbation
definition of,22
importance of,23–24
Orientation, and sexual identity,85
Outcomes, of love affairs,73
Paraphiliascase examples of,106, 108–109, 109–110
disorders listed in DSM-5,105–109
impact of on relationships,99–100
sexual addiction and,70
thwarting of love and,109–111
Paroxetine,42
Partner relationships.
See also Betrayals; Marriage
anorgasmia and,30–31
sexual desire and,56, 60
Pathogenesis, use of term in context,10
Patientsdiscussions of love,103
process of individual becoming,6–7
questions from about therapist’s sexual life,19, 95
therapist’s respect for privacy about sexual life of,1–2
therapist’s sexual identity alignment and,94–96
Performance anxietyerectile dysfunction and,36, 45
premature ejaculation and,13
Perimenopause,59
Personal aesthetics, as aspect of identity,82–83
Personality.
See Character traits
Pharmacotherapy.
See also Side effects
for erectile dysfunction,43–45
for premature ejaculation,14, 16–17
for sexual desire problems,53–54
Phosphodiesterase-5 (PDE-5) inhibitors.
See also Sildenafil
elderly and requests for,104
erectile dysfunctions and,34, 43–45
premature ejaculation and,14, 17
understanding of mechanisms of action,11
Political self, as aspect of identity,83
Pornography, and sexual addiction,71.
See also Commercial sex
Premature ejaculation.
See also Rapid ejaculation
illustrations of forms of,19
symptom pattern of,13–17
Prevalenceof anorgasmia,23
of dyspareunia,117
of sexual desire problems,50
of transgender identity in adolescents,86
Prisons.
See also Forensic settings
gender dysphoria and,89–90
paraphilic disorders and,105
Privacy, respect for patient’s about sexual life,1–2
Prognosis, and erectile dysfunction,42–43
Provoked vulvodynia,115
Psychiatry.
See also Mental health professionals
concept of “disorder” and history of,81–82
emphasis on diagnosis, medication management, and evidencebased interventions in,131
Psychogenic erectile dysfunction,35–36, 38–39, 41–42
Psychological component, of sexual desire,51–52
Psychosis, and psychotic disorders.
See also Psychotic depression
gender dysphoria and,89
sexual desire and,56
Psychosomatic impairments, and sexual dysfunctions,117
Psychotherapy.
See also Group therapy; Individual therapy; Mental health professionals
commonalities of love and,127–128
for erectile dysfunction,45–47
facilitation of maturation as goal,119
as generic term,126–127
shift away from in psychiatry,131
treatment of delayed ejaculation and,19
Psychotic depression, and genito-pelvic pain/penetration disorder,120
Quality of life, and menopause,61
Rapid ejaculation.
See also Premature ejaculation
in adolescents or young adults,14
recently acquired form of,18–19
“Rapid onset of gender dysphoria,”86
Reality, erectile dysfunction and construction of new,40–41
Religious beliefs, as aspect of identity,83
“Reparative therapies,” for erectile dysfunction,45
Research, and professional development,129–130
Resistancehelping patients to articulate sexual history in cases of,29
treatment of erectile dysfunction and,41
Respect, for patient’s privacy about sexual life,1–2
Sadomasochism, and paraphilic disorders,99, 107–109
Safe harbor, as metaphor in treatment of erectile dysfunction,46
Selective serotonin reuptake inhibitors (SSRIs),17
Self-labels, for gender identity,87
Sensuality, functional sexual life and aspects of,13
Sex Addicts Anonymous,70
Sexual abuse, as form of betrayal,64, 67–68
Sexual addiction, and betrayals,68–72
Sexual aversion disorder,53, 58
Sexual behavior, as distinct from eroticism,2–3
Sexual desireacquired versus lifelong forms of issues with,55–59
biological sex as component of,49–50, 51
case examples of,53, 56, 57
clinical sexuality and concept of,49
cultural component of,49, 52
individual variation in,52–54
menopause and,50, 59–61
psychological component of,51–52
Sexual dysfunctions.
See also Anorgasmia; Premature ejaculation; Sexual desire
betrayals as source of,64
biological and life cycle perspectives on,9
concepts of etiology, pathogenesis, and pathways of,10
concepts of love and treatment of,104–105
differences between problem, dilemma, and conundrum,123–125
impact on therapist of working with,7–8
medical specialties and diversity of approaches to,11
sexual identity and,95–96
similarities among types of,117–118
sources of learning about,5–6
textbooks on,135
Sexual functiondesire, arousal, penetration, and orgasm as components of,5
as dimension of sexuality,5
problematic in individuals with autism,114–115
Sexual historyerectile dysfunction and,36
helping patients to articulate,28
menopausal transition and,61
partner relationship as factor in anorgasmia and,30
Sexual identity.
See also Identity
as dimension of sexuality,5
gender identity, orientation, and intention as components of,5, 85
gender incongruence and,85–94
paraphilic interests and,110
possible combinations of therapist’s and patient’s,94–96
of therapist and discussions with patients about rapid ejaculation,18–19
Sexualityconcept of sexual desire and,49
different characteristics of at different stages of life,104
history of in medical writings,4
journals on,135
major organizations and,136
respect for privacy of patient’s sexual life,1–2
sexual identity and sexual function as dimensions of,5
Sexual masochistic disorder,107–109.
See also Sadomasochism
Sexual minority community.
See also LGBTIQA community
substance abuse, alcoholism, and suicide in,96
use of term,81
Shoplifting,18
Side effectsof bremelanotide,54
of flibanserin,54
Sildenafil,43, 45, 130
Situational anorgasmia,22
Social identity,84
Social isolationfantasies and,70
paraphilias and,109
Social relationships, and risks of gender reassignment,91–92
Somatic symptoms, as response to betrayals,65–66
Substance abuse.
See also Alcohol use
gender dysphoria and,89
paraphilias and treatment for,109
sexual minority community and,96
Suicide, and sexual minority community,96.
See also Alcohol use
Supreme Court, and marriage equality,87
Tadalafil,43
Therapeutic alliancepsychotherapy for erectile dysfunction and,45–47
sexual identity of therapist and patient,94
Therapeutic relationship, and psychotherapy,126–127
Therapists.
See Mental health professionals
Therapy team, for treatment of erectile dysfunction,45–46
Topical anesthetics,14, 17
Tramadol,14, 17
Transgender identity.
See also Gender identity; LGBTIQA community
prevalence of in adolescents,86
therapeutic alliance and transfriendly or trans-competent therapist,95
Transsexual identity, and gender binary concept,86.
See also Gender identity
Traumagender dysphoria and,89
helping patients to articulate sexual history and,28, 29
sexual aversion and,58
Unfaithfulness, negative implications of term,72
Unrecognized orgasm,22
Vaginismus,115
Values, and sexual desire,52.
See also Morality
Vardenafil,43
Vestibulodynia,115
Voyeuristic responses, by therapists,3
Women’s Health Initiative (2002),60
World Professional Association for Transgender Health (WPATH),90, 93
