To Tenille, I thank you for your commitment to our healthcare team. I must thank my parents in advance for their courage and support to endure the undoubted snickers that they may encounter because their son is a sexual medicine specialist and has written a book about human sexuality. I can only hope that this book will not embarrass them too much and that they continue to be proud. For Steven, Nancy, Hailey, and Gregory, my favorite and special Aunt Ann, the Franconi family, and the others who have touched my life and have given me unconditional support, your thoughts do not go unappreciated. Dr. Susan Kellogg—I am fortunate to have you as a colleague and a special friend.

Julianna and Russell, you never cease to amaze and thrill me, I hope that one day, both of you may benefit from the information in this book and find it useful during your own personal relationships. (P.S. Just please, don't tell me about it.) To my family, who have endured the late nights and key pad banging, thanks for free passes to have time to commit to my career and writing; your support is always appreciated and does not go unnoticed.

This is not merely another book about sex or sexual function; I would hope people who read this understand there is much more to sex and relationships than the physical aspects. I hope that intimacy and connectedness resound in the pages of this book and that many will benefit in their journeys of couple hood.

No relationship is ideal or perfect. Sometimes even the clearest of relationships can become clouded, and often you can lose your way or become confused. There is not one formula for success and neither does sexual health and wellness follow a single, cookie-cutter treatment. No two couples are the same in their needs and wants. Luckily, I have been fortunate to have learned much from many of the loving and supportive couples I have come across in my years. Each has taught me something unique and special, and

I can hope to write their lessons and words of wisdom on paper. A special thank you for Paul and Muriel, Steven and Nancy, Joe and Rose, Susan and Kirk, Tom and Judy, Vera and Morty, Cammy and Olga.

I would also like to extend a thank you to all the women who are brave enough to seek out care from a sexual healthcare professional—they have the courage to demand improved quality of life and want connectedness with their loved one.

Every day during my California commute, I travel along the Pacific Coast Highway and enjoy the ocean's beauty and breezes on my way to the office. Since living in California, I have learned that the ocean can often serve as a metaphor for intimate relationships. Close connections with other people are sometimes like the ocean: sometimes they are smooth, serene, and pleasing while at other times they can be stormy, troublesome, or even frightening. But personal and life experiences have taught me that the keys to relationship success include communication, compromise, cooperation, patience, selflessness, compassion, and understanding.

I hope that this book will serve as a helpful blueprint for all women, of all ages, races, cultures, orientations, and background, so that they have the knowledge, insight, tools, and self-awareness to weather any storm.

Sensuality, Sexuality, Dysfunction, and Assessment

What is sexual medicine?

Sexual medicine means different things to different people. To some it conjures up images of intense therapy sessions delving into your sexual past and upbringing, whereas to other individuals it represents a complete medicalized approach to sexuality[1]. Others still take the approach of a comprehensive yet dynamic definition. The most common definition of sexual medicine describes it as the medical discipline that embraces the study, diagnosis, and treatment of sexual health concerns of both men and women. Another interesting and thought-provoking definition is used at this author's center, the Southern California Center for Sexual Health and Survivorship Medicine located in Newport Beach. There, sexual medicine and health is described as the discipline that seeks to enhance the lives of patients and their partners through assessment and treatment of the physical, psychological, medical, and surgical causes of sexual and intimacy concerns.

Although sexual medicine is not an accepted discipline of formalized medical school study, many healthcare institutions and educational programs are embracing the notion of sexual health and intimacy as an important facet for overall patient quality of life. Sexual health involves many disciplines including urology, gynecology, psychiatry, and other fields of medical study. Many recognize that the interface of medical experience, or the mere fact of going to see a doctor, no matter what the diagnosis, often changes their relationships. Health-care teams now understand that to better serve their patients, the concept of sexual intimacy must be addressed in study and treatment.

Sexual complaints are common in both men and women, and failure to have these problems diagnosed and treated effectively can lead to both personal distress and relational disruption. Sexual complaints are independent of race, color, and creed or ethnicity. Women of all races and backgrounds are at risk for and complain of sexual issues. Although much of

Sexual medicine and health is described as the discipline that seeks to enhance the lives of patients and their partners through assessment and treatment of the physical, psychological, medical, and surgical causes of sexual and intimacy concerns.

the sexual medicine research and information readily available typically focus on the upper-middle-class Caucasian female, new data support that minority women and those of different socioeconomic classes should also be asked about, assessed, and treated for sexual complaints. Sexual health and wellness is often influenced by a variety of cultural issues. With respect to African American and other minorities and sexual wellness, there may be some barriers; disparities based on gender, race, and other factors inhibit many minority women from acquiring the tools for sexual health. These women often lack access to good medical health care let alone sexual medicine services. Sometimes negative sexual stereotypes affect sexual self-esteem and also inhibit the path to sexual awareness and wellness. For example, historical myths surviving since the time of slavery and other points in black history perpetuate falsehoods about African American women, such as the notion of their hypersexuality as well as prevailing thoughts that many women enjoy sexual activity or are "loose" or "dis-inhibited"; these are falsehoods that many women struggle to overcome even today.

According to the World Health Organization Report on Education and Treatment in Human Sexuality, sexual health is the integration of the somatic, emotional, intellectual, and social aspects of sexual being in ways that are positively enriching and that enhance personality, communication, and love. Sexual health should not be a privilege of the few and well insured—all women deserve access to well-qualified sexual health specialists.

Raye comments:

Sexual medicine is the specialty that deals with sexual health. It can be anything from sexual disorders to concerns with your body. Pain or low sexual interest are common problems too. I really didn't even know that it existed until a friend told me about it. I was suffering in silence and thought that I was alone. It's not true. You do not have to suffer alone; there is help available.

  • [1] The feelings, behaviors, and identities associated with sex.
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