Introduction

Sexual problems and their management require a particular sensitivity in the therapist because the subject matter of the discourse between the client (or patient) and the therapist (or doctor) is the intimate sexual interaction of two people. The areas being discussed are rarely if ever spoken about in a serious way outside the intimate relationship itself. In some types of therapy a physical examination also has to take place. Here, too, sensitivity has to be exercised to avoid embarrassment and to put the patient at his or her ease while the examination is taking place or the devices to restore function are being demonstrated.

Background

The earliest form of sexual therapy in the UK was carried out at the Institute of Psychosexual Medicine (Tunnadine, 1970). The therapists were predominantly general medical practitioners trained by the psychodynamically oriented Dr Michael Balint. He used a ‘seminar’ method, in which groups of doctors met together with a supervisor. Many of the patients, and most of the doctors, were female, and the doctors were encouraged to carry out a vaginal examination, which could produce a ‘moment of truth’ in which the patient would reveal the reasons behind her presenting sexual problem. The method is still practised, but only in a minority of settings.

The foundations of sexual therapy as most widely practised today were put in place by Masters & Johnson (1970), who instituted the concept of the couple as the ‘unit’ for treatment, and used a combination of face-toface meetings between the couple and two ‘co-therapists’ with homework exercises for the couple. Masters & Johnson used a rather unusual approach in which the couple stayed at a hotel in the city where the therapy took place, and attended the clinic every day for 2 weeks. Their methods have been imitated in many different settings, but in most of these the couples have attended once or twice a week at a clinic within travelling distance from their home address.

Sexual therapy takes many different forms, and there are many different professionals involved in the field.