What are structured sexual exercises and what is behavioral modification? How do these help treat sexual complaints?

Patients with sexual complaints are always encouraged to make lifestyle modifications that will enhance and improve quality of life. At the Southern California Center for Sexual Health and Survivorship Medicine, we often use a holistic approach and stress diet, exercise, and lifestyle changes to promote sexual health and wellness. A well-balanced nutritious diet with appropriate caloric intake and adherence to the Food Pyramid is important. Increased fruits and vegetable as well as a diet rich in antioxidants is also encouraged. Diet combined with an active aerobic exercise plan is vital. A vigorous exercise plan can increase brain endorphins, which are natural pain killers, and also release a variety of mood-enhancing neurohormones. Stopping the use of tobacco and illicit drugs is important. Minimizing alcohol consumption is also encouraged. If fatigue or tiredness is a problem, we encourage you to take frequent naps and plan sexual intimacy when you are well rested.

The incorporation of time and stress management skills is vital. We have become a nation of overworked, overscheduled, stressed individuals too busy for sexual intimacy. Sometimes it is important to schedule alone time to recharge your personal energy. Others find it helpful to schedule time for sex and intimacy. Sexual intimacy needs to become a priority for you and your partner. Set limits on other commitments such as employment, social responsibilities, and family obligations. Refocus your energies on your partner and your intimate time together. Sexual connectedness will help your overall health and improve your ability to handle many of life's challenges.

Similarly, you may be given specific sexually structured tasks to identify and help treat specific sexual complaints. Some examples of behavior modification sexual techniques include the following:

• Erotic reading: Try reading an erotic novel in a quiet relaxed place. This may rekindle some sexual thoughts or interests.

• Sensate focusing: Concentrate on your physical sensations. (This is discussed in further detail later.)

• Squeeze-stop techniques: This technique may be helpful for men with erectile concerns or premature ejaculation. The squeeze technique is when a man or his partner squeezes the penis[1] before the point of ejaculatory inevitability. The stop-start technique is when the man stops stimulation as he senses getting closer to the point of ejaculatory inevitability.

• Guided imagery: Imagine a particular sexual scenario.

• Relaxation techniques: Breathing and exercises may help you reconnect with your body and help lessen the stress you are experiencing.

• Exploration of sexual fantasies: Discussing sexual fantasies with your partner may help communication and eliminate sexual boredom. Some suggest using physical props like costumes or sexual accessories or mental imagery.

• Self-stimulation (masturbation[2]) exercises: Self-stimulation is discussed later in Part Five.

You might be assigned homework in the form of sexual exploration. These activities may include nongenital touching, self-stimulation exercises, and other sexual exercises to improve and enhance your sexual self-esteem. You and your partner are educated through the use of open discussions concerning alternate forms of sexual expression, such as mutual massage, intimate fondling and caressing, and manual, digital, oral, and anal stimulation. Let your imagination be your guide.

Sometimes cueing exercises are also helpful. These exercises try to increase sexual self-esteem by helping you focus on a place and time in your life when you felt very sensual and sexy. Certain cues in the environment facilitate you looking and feeling attractive and sexy to others and yourself. Think back and try to remember your characteristics during this phase of your life. What was your hair like? Your body type or size? Your favorite scent or perfume? Music you enjoyed, or diet you enjoyed? It is likely that these cues are the key to your sense of sensuality and sexiness. Take a moment and write them down on a piece of paper. Think about incorporating them into your present-day routine and lifestyle. By association, you may feel that your sexual interest is rekindled.

You and your partner may be encouraged to engage in alternative sexual positions. Most couples engage in intercourse in the missionary position, which facilitates deep penetration. Some feel this is the best position in which to conceive a child because deep penetration places sperm near the cervix. But this position can sometimes be very painful for women who have shortened vaginas in association with vaginal and vulvar atrophy; rarely is the G-spot stimulated either.

Sexual intercourse in alternative positions may include side-to-side (spooning) or female-superior positions, where the woman is on top. These positions may help limit deep pelvic thrusting and minimize vaginal discomfort during penetration. Sometimes shallow thrusts or varying the depth, force, and vigor of movement can also change excitation and arousal. Some other sexual positions facilitate direct clitoral stimulation, which can greatly increase arousal in many women. If movement and mobility are issues, such as with chronic arthritis, bone and/or joint illness, osteoporosis, or fibromyalgia, use pillows or down comforters to help create a comfortable sexual situation. Use them liberally to support your body, back, and pelvis to avoid muscle strain.

Exercises may also enhance emotional connectedness and lead to a greater sense of emotional bonding.

  • [1] The erectile, sexually, erotically sensitive organ in males. The penis serves a sexual function and also mediates the voiding of urine.
  • [2] The act of self-pleasuring; also known as self-stimulation.
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