Specific treatments

Behavioural therapy

Based on Masters and Johnson’s approaches, these methods are today called modified Masters and Johnson where couples are given graded sexual exercises. During the first stage, all genital sexual contact is banned, but the couple is encouraged to explore each other’s bodies using tactile touching and massage, taking turns to please each other. This stage is known as non-genital sensate focus, and, after two to three sessions per week for a few weeks, the couple can move to the next stage of genital sensate focus, especially if they are making good progress. In this stage, actual intercourse still remains banned, but the couple can touch each other’s external genitalia. The purpose is to improve both verbal and non-verbal communication. Once the couple have learnt these strategies, they can add specific interventions, according to the underlying condition. For example, they may use the ‘squeeze technique’ in cases of premature ejaculation, or they could use ‘overstimulation’ in cases of retarded ejaculation. Throughout, cognitive elements are included to reduce anxiety, challenge stereotypes, and reduce generalizations and catastrophizing. For women with anorgasmia or vaginismus, exposure and behavioural therapies have been shown to be effective and successful. For vaginismus, using vaginal dilators, whilst managing anxiety, and then gradually increasing their size will help.

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