THE eee NEW esc SEX ~ THERAPY HELEN SINGER KAPLAN, M.D.,Px.D. Clinical Associate Professor of Peyehiatry and Coordinator of Student Teaching of Psychiairy, Cornell University College of Medicine; Head of the Sex Therapy and Education Progra, Payne Whitney Clinic of the New York Hospital A Brunner/Mazel Publication published in cooperation with Quadrangle/The New York Times Book Co. 7 eee Saaie eee ce eeTo SIDNEY (Copyright ©1974 by Helen Singer Kaplan, MLD. Ph.D. AA Brunner/ Mail Publication published in operation with ‘Quadrangle The New York Times Book Coy, 10Easc 58 Stee, New York, New York 10022 Distributed in Canada by 1140 Beaulae St, St. Laurent 882, Quebec All sights reserved. No part ofthis book may be reproduced by any proces whataoever, without the written permaaion ofthe copyright owen Library of Congress Catalog Card No, 78-87724 SBN a7630-088"2 CONTENTS FAMILIEISI A COPLULUI IASI BIBLIOTECA AREA I / BASIC CONCEPTS 1 CHAPTER 1 THE ANATOMY AND PHYSIOLOGY OF THE SEXUAL RESPONSE 5 CHAPTER 2 THE BRAIN AND SIX. 34 CHAPTER 3 HORMONES AND SEX 46 AREA II / ETIOLOGY 68 A The Biological Determinants of the Sexual Dysfunctions 69 Guarren 40 THE EPPECIS OF ILLNESS ON SEXUALITY 75 CHAPTER 5 THE EFFECTS OF DRUGS ON SEXUALITY 86 GUAWTER 6 THLE EFFECTS OF AGE ON SEXUALITY 104 B- The Paychological Determinants of the Sexual Dysfunctions 117 CHAPTER 7 THE IMMEDIATE CAUSES OF SEXUAL DYSFUNCTIONS 121 CHAPTER 8 CONFLICT—INTRAPSYCHIC CAUSES OF SEXUAL DYSFUNCTIONS 187 GHAPTER 9 THE RELATIONSHIN—DYADIC CAUSES OF SEXUAL DYSFUNCTIONS 155 GuApreR 10 LEARNED CAUSES OF SEXUAL DYSFUNCTIONS 173vi J. Contents AREA I / TREATMENT 185 cuarren 11 nAsig PRINCIPLES OF sex THERAPY 187 CHAPTER 12. THE THERAPEUTIC EXPERIENCES’ 201 CHAPTER 13 THE"PSYCHOTHERAPEUTIC SESSION “221 14 OnweR 1588S IN SEX THERAPY: CONJOINT TREATMENT -TRANSFERENCE AND COUNTERTRANSFERENCE 235 AREA IV | THE SEXUAL DYSFUNCTIONS 249 A. The Sexual Dysfunctions of the Male 255 (CHAPTER 15 ERECTILE DYSFUNCTION (iMPoTENE) 255 cuarren 16 PREMATURE EJACULATION 289 cuArTeR 17 RETARDED EJACULATION 816 B_ The Sexual Dysfunctions of the Female 889 CHAPTER 18 GENERAL SEXUAL DYSFUNCTION (FRIGIDITY) 561 CHAPTER 19. OKGASTIC DYSFUNCTION 874 cuapren 20. vaciNismus 412 AREA V / RESULTS 431 CUAPTER 21 THE RESULTS OF SEX THERAPY. 435 AREA VI / SPECIAL CLINIGAL PROBLEMS 463 CHAPTER 22 SEXUAL DYSFUNCTIONS IN BOTH PARTNERS 469 CHAPTER 23. SEXUAL DYSFUNCTIONS AND PSYCHIATRIC DISORDERS 474 (CHAPTER 24 SEXUAL DYSFUNCTIONS AND MARITAL DISCORD 50 BY CLIFFORD J. SAGER, M.D. xpmocur 519 INDEX 525 LIST OF ILLUSTRATIONS ricure IA The Female Genitals in a Quiescent State 6 riourt IB) The Male Genitals in a Quiescent State 7 rigunz 2A The Female Genitals in a Highly Aroused State (Plateau) 8 higune 2B The Male Genitals in a Highly Aroused State (Plateau) 9 ricure 8A. The Female Genitals during Orgasm 10 ricure 8B The Male Genitals during Orgasm 11 ricune 4 Male Genital Anatomy 16 ricuke 5 Female Genital Anatomy 24 rioure 6 The Sexual Response Reflexes 36 ricure 7 Cerebral Localization of Erection 39 rout 8 Cerebral Basis for Self and Species Preservative Behavior 41 figure 9 Testosterone and the Brain 47 foun 10 Variations in Estrogen and Progesterone Levels during the ‘Menstrual Cycle 56 rious 11 Menstrual Cycle Phase and Combined Incidence of Morbidity inaNormal Population 56 rioune 12 Menstrual Cycle Phase and Combined Incidence of Prycho- pathologic Behavior 56 ricue 18 Non-Demanding Stimulation of the Female Genitals 210 Hicuae 1d The Semans Procedure for the Treatment of Premature Ejac ulation 304 nicure 15 The Side-to-Side Position 808 noun 16 Manual Stimulation of the Penis during Goitus 324 ricune 17 Hypothetical Distribution of the Female Orgasm 379 ricurs 18 Female Superior with Clitoral Stimulation 404 Freune 19 Man Stimulating Woman's Clitoris during Coitus 406 ricue 20. Self-Stimulation during Coitus 408 Figures 13, 14, 15, 16, 18, 19 and 20 are by Betty Dodson. Figures 1, 2,3, 6 and d were done by Barbara Rankin; Figure: 10, 11, 12 and 17 were done by Simon Rost Studios. wi