Showing papers in "Journal of Sex & Marital Therapy in 2016"

Being Sexually Attracted to Minors: Sexual Development, Coping With Forbidden Feelings, and Relieving Sexual Arousal in Self-Identified Pedophiles

Abstract: This article aims to provide more insight into pedophilic attraction and risk and protective factors for offending in nonclinical pedophiles. Fifteen participants were interviewed about sexuality, coping, and sexual self-regulation. Many participants struggled with acknowledging pedophilic interest in early puberty and experienced psychological difficulties as a result. Furthermore, many committed sex offenses during adolescence when they were still discovering their feelings. Early recognition of risk factors and early start of interventions seem vital in preventing offending. Moreover, results suggest that risk for offending can be diminished by creating more openness about pedophilia and by providing pedophiles with social support and control.

Is High Sexual Desire a Facet of Male Hypersexuality? Results from an Online Study.

Abstract: Despite a growing number of studies, hypersexuality remains controversial and empirically elusive. Using a group comparison approach, this study revisited the claim that hypersexuality cannot be reliably distinguished from high sexual desire. An online survey, advertised as focusing on pornography use and sexual health, was carried out in 2014 among 1,998 Croatian men aged 18 to 60 years (Mage = 34.7, SD = 9.83). Membership in the hypersexuality group (HYP; n = 57) was determined using the Hypersexual Disorder Screening Inventory and the Hypersexual Behavior Consequences Scale. The highest values on two indicators of sexual desire/interest set membership in the high sexual desire group (HSD; n = 70). The overlap between the groups was negligible (n = 4). Compared to the rest of the sample, men in the HYP group had significantly higher odds of being single, not exclusively heterosexual, religious, depressed, prone to sexual boredom, experiencing substance abuse consequences, holding negative attitudes towa...

A Review of Supportive Interventions Targeting Individuals or Couples Undergoing Infertility Treatment: Directions for the Development of Interventions.

Abstract: The purpose of this systematic review is to explore the types, content, and outcomes of different psychosocial approaches used in existing interventions for infertile individuals or couples. Relevant intervention studies published in English between 2000 and 2014 were searched using the electronic databases MEDLINE, PsycINFO, and CINHAL Plus. A total of 23 articles were identified and included in this review. Cognitive behavioral therapy (CBT), acceptance and commitment therapy (ACT), and counseling were the most commonly adopted psychosocial interventions for infertile individuals or couples. After reviewing the various approaches, directions are given on the development of interventions for couples suffering from infertility.

Further Validation of the Female Sexual Function Index: Specificity and Associations With Clinical Interview Data

Abstract: Female sexual function is a multi-faceted psychophysiological construct. The Female Sexual Function Index (FSFI) is considered a "gold standard" self-report instrument that assesses the various aspects of sexual function. However, researchers have recently proposed potential limitations of the FSFI, highlighting the need for continued validation research. The aims of the current analyses were (a) to assess the correlations between FSFI scores and information regarding specific rates of functional impairment gained via clinical interview; and (b) to assess the specificity of FSFI subscale scores in reflecting corresponding aspects of sexual function (e.g., whether the Sexual Desire subscale reflects sexual desire specifically rather than sexual arousal, orgasm, etc.). The participants were 97 sexually active women who reported impairments in sexual function. Clinical interview data exhibited moderate-to-strong correlations with FSFI scores. Additionally, FSFI subscales generally exhibited adequate specificity in terms of reflecting their corresponding aspects of sexual function more strongly than other aspects. The results generally supported the validity of the FSFI. Implications for the measurement and conceptualization of female sexual function are discussed.

Effects of Infertility Etiology and Depression on Female Sexual Function

Abstract: Sexual dysfunction is common in women with infertility and interferes with the marital relationship. The study aims to compare sexual function among women with different infertility causes. The authors used a cross-sectional study design with 142 infertile women. Sexual functions and depression prevalence of infertile women were assessed using the Female Sexual Function Index and the Beck Depression Inventory. The prevalence of female sexual dysfunction was 43.3% (n = 13) in the female infertility group (Group A), 54.8% (n = 17) in the male infertility group (Group B), and 51.9% (n = 42) in the unexplained infertility group (Group C). There was no statistically significant difference in the prevalence of sexual dysfunction between the groups (p =.635). There was no significant difference in mean Beck Depression Inventory scores between the groups (p =.832). However, Beck Depression Inventory scores and depression prevalence were significantly higher in women with sexual dysfunction (p <.001). The total Fe...

Pornography Use and Sexual Behavior Among Polish and German University Students.

Abstract: The purpose of this study was to explore the relationship between pornography use and sexual behavior in young adults from two culturally different countries. Data were collected in an online survey among German (n = 1,303; G) and Polish (n = 1,135; P) university students aged 18 to 26 years. Pornography use was associated with engaging in a greater variety of sexual activities (e.g., sexual role playing, using sex toys; G > P) rather than with a high number of sex partners or condom use consistency. The differences between the samples were found primarily for females (in anal sex experience and age at the first sexual intercourse; G > P).

Sexual satisfaction in spanish heterosexual couples: testing the interpersonal exchange model of sexual satisfaction

Abstract: The study of sexual satisfaction in Spain is scarce and has proceeded atheoretically. This study aimed at examining sexual satisfaction in 197 Spanish heterosexual couples based on the Interpersonal Exchange Model of Sexual Satisfaction. Men and women reported equal satisfaction. Men's sexual satisfaction was predicted by their own relationship satisfaction, balance of sexual rewards and costs, and comparison level of sexual rewards and costs. Women's sexual satisfaction was predicted by their own relationship satisfaction, balance of sexual rewards and costs, comparison level of sexual rewards and costs, equality of sexual costs, and their partner's balance of sexual rewards and costs. These results provide with a better understanding of the mechanisms that explain sexual satisfaction in Spanish couples. Implications for research and therapy are discussed.

Sexual Functioning in Young Women and Men: Role of Attachment Orientation

Abstract: Prior research has documented various ways in which adult attachment styles are characteristic of differential behavioral and cognitive patterns within romantic relationships and sexuality. However, few studies have examined the direct influence of anxious or avoidant attachment orientation on sexual function. The aim of the present study was to assess the impact of insecure attachment on sexual function. Undergraduate students completed questionnaires measuring attachment style and sexual functioning. Among women, attachment avoidance tended to be associated with impairments in all aspects of sexual function, whereas anxious attachment tended to be associated with declines in arousal, satisfaction, and ability to achieve orgasm. A different trend was seen in men: Anxious attachment tended to be associated with multiple facets of sexual dysfunction, while avoidant attachment did not correlate with any sexual function deficits and was associated with superior physiological competence. These results suggest that both anxious and avoidant attachment styles are important yet differential predictors of sexual function in men and women.

Empathy as a Mediator of Attitudes Toward Infidelity Among College Students.

Abstract: This study examined attitudes about infidelity among college students. Due to increased sexual opportunities and normalization of casual sex in the college campus environment, commitment level is generally more likely to be lower than for post-college-aged individuals. While lower commitment may contribute to infidelity among college students, we aimed to more closely examine the relative role of individual characteristics. The literature has shown that individuals with certain personality traits, such as narcissism and an insecure attachment style, are more likely to commit infidelity, but less is known about the interaction between sex and these traits and about possible underlying mechanisms that account for why some people resist the temptation to be unfaithful and others don't. Working under the assumption that higher empathy might be the underlying mechanism that enables individuals to resist the temptation to be unfaithful, we demonstrated that empathy partially mediates the relationship between sex, narcissism, entitlement, attachment style and attitudes toward infidelity in college students. Thus, college students who are securely attached, low in narcissism, and high in empathy are more likely to oppose sexual behavior outside of their dating relationships despite the fact that their commitment level may be relatively low.

Personality Traits, Sexual Problems, and Sexual Orientation: An Empirical Study

Abstract: Personality traits, namely neuroticism, have been suggested as vulnerability factors for the development and maintenance of sexual dysfunction in heterosexual samples. However, no evidence was found regarding homosexual samples. This study aimed to analyze the differences on personality traits between heterosexual and homosexual men and women with and without sexual problems. Participants were 285 individuals (142 men, 143 women) who completed a web-based survey. Participants answered the NEO Five-Factor Inventory, the Brief Symptomatology Inventory, and questions regarding sexual problems. The groups of men and women with and without sexual problems were matched for sociodemographic variables. A 2 (Group) × 2 (Sexual Orientation) multivariate analysis of covariance was conducted separately for each gender. Results indicated a significant main effect for group and for sexual orientation in male and female samples. Men with sexual problems scored higher on neuroticism, whereas women with sexual problems scored higher on neuroticism and lower on extraversion when compared with healthy controls, regardless of sexual orientation. In addition, gay men scored higher on neuroticism and lesbian women scored higher on conscientiousness compared with the heterosexual groups. The present findings emphasize the central role of neuroticism on sexual problems in both men and women regardless of sexual orientation.

Treatment of Female Sexual Pain Disorders: A Systematic Review.

Abstract: Sexual pain disorders affect women's sexual and reproductive health and are poorly understood. Although many treatments have been evaluated, there is no one "gold standard" treatment. The aim of this systematic review was to investigate what treatments for female sexual pain have been evaluated in clinical studies and their effectiveness. The search strategy resulted in 65 papers included in this review. The articles were divided into the following categories: medical treatments; surgical treatments; physical therapies; psychological therapies; comparative treatment studies; and miscellaneous and combined treatments. Topical and systemic medical treatments have generally been found to lead to improvements in, but not complete relief of, pain, and side effects are quite common. Surgical procedures have demonstrated very high success rates, although there has been variability in complete relief of pain after surgery, which suggests less invasive treatments should be considered first. Physical therapies and psychological therapies have been shown to be promising treatments, supporting a biopsychosocial approach to sexual pain disorders. Although most of the interventions described have been reported as effective, many women still experience pain. A multidisciplinary team with active patient involvement may be needed to optimize treatment outcome.

Female Genital Dialogues: Female Genital Self-Image, Sexual Dysfunction, and Quality of Life in Patients With Vitiligo With and Without Genital Affection

Abstract: Vitiligo has a major effect on sexual health because of the disfiguring skin lesions affecting self-image and self-esteem. However, this topic has not explored. This article aimed to assess the effect of vitiligo on genital self-image, sexual function, and quality of life in female patients. This cross-sectional study included 50 sexually active women with vitiligo and 25 women without vitiligo. All participants subjected to full history taking and examination. Extent of vitiligo was assessed with the Vitiligo Area Scoring Index score, sexual function with the Female Sexual Function Index, genital self-image with Female Genital Self-Image Score and quality of life with the Dermatology Life Quality Index questionnaires. The main outcome measures were correlation between Vitiligo Area Scoring Index, Female Genital Self-Image Score, Female Sexual Function Index, and Dermatology Life Quality Index domains was determined using t test and Pearson correlation. This study revealed a negative correlation between t...

Type 2 Diabetes Patients’ Needs and Preferences for Care Concerning Sexual Problems: A Cross-Sectional Survey and Qualitative Interviews

Abstract: Sexual dysfunction is highly prevalent among patients with type 2 diabetes; however, little is known regarding these patients' needs and preferences for care for sexual problems. A cross-sectional survey and 25 semistructured interviews were therefore conducted among 40- to 75-year-old type 2 diabetes patients to explore this. We learned from the survey and interviews that most participants were unaware of the association between type 2 diabetes and sexual problems. Although certain barriers for discussing sexual problems with a care provider were identified (e.g., feelings of embarrassment), patients still reported a need for discussing their problems, because sex was viewed as an important part of their relationship. Some patients had sought help, but were dissatisfied with the offered care. Patients experienced a lack of attention and information from diabetes care providers. Improving this, together with a care provider-initiated conversation, was suggested to lower the threshold for discussion. Moreover, patients preferred a care provider with whom they have a close relationship, whereas age, gender, and medical specialty were regarded to be less important. An important recommendation was to make care for sexual problems an integral part of routine diabetes care. Future research should look into these recommendations.

Pilates for Better Sex: Changes in Sexual Functioning in Healthy Turkish Women After Pilates Exercise.

Abstract: Although a large number of studies report the impact of daily exercise on many aspects of women's health, none of them address the relationship between Pilates exercise and sexual function prospectively. The aim of this study was to assess the effect of Pilates exercise on sexual function in healthy young women using a validated questionnaire. In total, 34 premenopausal healthy Turkish women aged between 20 and 50 years who had regular menstrual cycles and sexual relationships were included in the study. Women were asked to complete Beck Depression Inventory (BDI) and Female Sexual Function Index (FSFI) questionnaires. Questionnaires were completed before and after 12 weeks of Pilates exercise. Primary endpoints were changes in total and individual domain scores on the FSFI and BDI. After the 12-week Pilates intervention, BDI scores were decreased and all domains of the FSFI were significantly improved with mean ± SD total FSFI scores increasing from 25.9 ± 7.4 to 32.2 ± 3.6 (p <.0001). This is the first ...

An analysis of the concept of partnership in the couples undergoing infertility treatment

Abstract: The elements of a partnership in the couples undergoing infertility treatment are not well understood. This article aims to fill the gap by using Rodger's evolutionary method of concept analysis. The attributes of the concept partnership that were identified are a process of joint hardship, sharing, intracouple communication, and mutual support. The antecedents are love and attraction for each other, agreement, and interpersonal skills. The consequences are marital benefit, improvement in psychological status, and quality of life. A middle-range model for partnership in relationship to infertile couples is proposed. The understanding of the phenomenon of partnership will enable the researchers to develop interventions, identify the appropriate assessment instruments, and to determine directions for future research on effort to support infertile couples through their hardship.

Automatic Thoughts During Sexual Activity, Distressing Sexual Symptoms, and Sexual Orientation: Findings from a Web Survey

Abstract: Studies with heterosexual samples have supported the role of cognitions on sexual functioning in men and women. However, there is no research on the impact of automatic thoughts on sexual functioning in sexual-minority samples. Therefore, the current study aimed to analyze the differences in automatic thoughts during sexual activity between gay and heterosexual men, and lesbian and heterosexual women, with and without distressing sexual symptoms, in order to establish similarities and differences between samples. A web survey was completed by 156 men and 168 women. A group of men and women with distressing sexual symptoms (78 men and 84 women) and a group without distressing sexual symptoms (78 men and 84 women) equally distributed in terms of sexual orientation and matched for sociodemographic variables were constituted. Participants answered a sociodemographic questionnaire, a questionnaire about sexual symptoms, and an automatic thoughts measure. Main findings suggested that men and women with distress...

Development and Validation of the Maternal and Partner Sex During Pregnancy Scales.

Abstract: Little is known about current attitudes in the United States toward having sex during pregnancy. It is possible that pregnant women and their sexual partners hold beliefs and have feelings during this time that might lead to sexual and relational distress. Two new scales, Maternal Sex During Pregnancy and Partner Sex During Pregnancy, were developed and administered to 112 newly pregnant couples. The scales demonstrated strong reliability and validity. Attitudes and beliefs varied across the sample, but the scores did not significantly differ between partners. These scales allow clinicians to support healthy sexuality during pregnancy by understanding sources of anxiety and possible misconceptions.

Pilot Study on the Effect of Botanical Medicine (Tribulus terrestris) on Serum Testosterone Level and Erectile Function in Aging Males With Partial Androgen Deficiency (PADAM)

Abstract: This study was conducted on 30 consecutive male patients presenting to Kasr-Al Ainy Andrology outpatient clinic complaining of manifestations of partial androgen deficiency in aging males (PADAM). In this study (750 mg/day) of Tribulus terrestris in 3 divided doses, each of 250 mg, as an endogenous testosterone enhancer had been tried for a duration of 3 months and the evaluation of its effect had been monitored for each patient concerning its effect on serum testosterone (total and free) and luteinizing hormone (LH), as well as its impact on erectile function, which was evaluated by the International Index of Erectile Function-5 (IIEF-5) questionnaire for those patients. Results showed a statistically significant difference in the level of testosterone (total and free) and IIEF-5, but no statistically significant difference in the level of LH before and after treatment. Also, the study showed statistically significant correlation between testosterone (total and free) and IIEF-5, but no statistically sign...

Subjective Sexual Well-Being in Chilean Adults: Evaluation of a Predictive Model

Abstract: Research on sexuality has traditionally focused on sexual satisfaction, with studies into subjective sexual well-being being a recent phenomenon. This study sought to evaluate the relationship between sexual behavior, happiness, health, and subjective sexual well-being. The data were collected from 862 people aged between 18 and 50 years in Santiago, Chile, and were analyzed by logistic regression analysis. The results showed that sexual behavioral indicators (sexual frequency, sexual caresses, and touching), happiness, and perception of health taken as a whole predicted 47.4% of subjective sexual well-being (SSWB). Analysis of the four items of subjective sexual well-being separately showed that the dimension of physical satisfaction was associated with three variables of sexual behavior indicators with a prediction percentage of 33.5%, whereas emotional satisfaction was associated with three variables of sexual behavior indicators and happiness, with a percentage of prediction of 43.3%. Satisfaction wit...

Partners’ Similarity in Differentiation of Self is Associated With Higher Sexual Desire: A Quantitative Dyadic Study

Abstract: The relationship between sexual desire and differentiation of self in couples has been frequently discussed in clinical literature but lacks empirical support. This exploratory study investigates the associations between individual and dyadic levels of sexual desire, differentiation of self, and couple satisfaction. Similarities and discrepancies in sexual desire and differentiation of self between partners were especially targeted. Partners were expected to have a lower discrepancy of differentiation of self than unrelated individuals (Bowen's similarity hypothesis). Partners' discrepancy in differentiation of self was expected to be negatively associated with sexual desire, and higher levels of sexual desire and differentiation in the dyad were expected be positively associated with couple satisfaction. Results suggest that partners' similarity regarding differentiation of self predicted individual sexual desire. Other findings suggest that couple satisfaction was positively associated with both sexual desire and differentiation of self. Limitations and clinical implications are discussed.

The Impact of Peyronie's Disease on the Patient: Gaps in Our Current Understanding

Abstract: Peyronie's disease results in a fibrous inelastic scar or hard plaque of the tunica albuginea of the penis that causes penile curvature deformity during erection that can be painful, distressing, and an impediment to sexual intercourse. In this article, the authors examine the knowledge gaps and research needs regarding the effect of Peyronie's disease on the patient's physical and psychological quality of life and on interpersonal relationships. On PubMed, the authors used the search terms Peyronie's disease, psychological, psychotherapy, male sexual dysfunction, partner, comorbid disease, satisfaction, and pain. Four categories describing the effect of Peyronie's disease were identified: (a) sexual dysfunction due to pain and altered penile shape, (b) psychological effects, (c) partner and relationship effects, and (d) effects of treatment options for Peyronie's disease. Results indicate that the examination of interventions aimed at education, coping, relationship distress, and sex therapy that may significantly improve patient quality of life is a core unmet need in Peyronie's disease. For many patients, the effect of Peyronie's disease is functional and psychological. Both aspects should be evaluated and treated in patients, which may require a referral. The physical pain, emotional distress and isolation, and partner and relationship discord that may be present require more attention.

Positive and Negative Affect During Sexual Activity: Differences Between Homosexual and Heterosexual Men and Women, With and Without Sexual Problems

Abstract: Empirical research suggests that emotional response during sexual activity discriminates between sexually functional and dysfunctional heterosexual men and women, with clinics presenting lower positive and higher negative affect. However, there is no evidence about the role of emotions in gay men and lesbian women with sexual problems. The present study analyzed affective states during sexual activity in homosexual and heterosexual men and women, with and without sexual problems. Participants in this study were 156 men and 168 women. A 2 (group) × 2 (sexual orientation) multivariate analysis of variance was performed. Participants completed a web-survey assessing sexual functioning and the Positive Affect-Negative Affect Scale. Findings indicated a main effect of group, with groups with sexual problems reporting significantly more negative and lower positive affect compared with men and women without sexual problems, regardless of sexual orientation. However, findings have also shown an interaction effect in the male sample with gay men, contrary to heterosexual men, reporting similar affective responses regardless of having a sexual dysfunction or not. Overall, findings emphasize the role of affective responses during sexual activity in men and women with sexual problems, suggesting the importance of addressing emotional responses in assessment and treatment of sexual problems in individuals with different sexual orientations.

The Association Between Female Sexual Dysfunction and the Husband's Erectile Dysfunction: Evidence from Married Couples in Hong Kong.

Abstract: Little is known about the association between the sexual functioning of each partner in a heterosexual married couple. By using a community-based survey of Hong Kong Chinese couples in 2012, this study attempted to examine the relation between female sexual dysfunction and their husbands' erectile dysfunction. Among the 1,518 female and 1,059 male respondents, 944 sexually active couples were eligible for the analysis, with mean age of 39.3 ± 6.8 years (range = 21-50) for the wives and 43.6 ± 8.6 years (range = 18-80) for the husbands. Of the wives, 27.0% reported at least one form of female sexual dysfunction and 5.0% of the husbands reported erectile dysfunction. After adjusting for the female's age and other risk factors, the total and domain scores of female sexual dysfunction were not associated with her husband's erectile dysfunction except for physical pain during sexual intercourse. Therefore, whether to screen the partner's sexual function depends on the age of the female clients.

Women in "Sexual" Pain: Exploring the Manifestations of Vulvodynia.

Abstract: This study explored the sexual and pain histories and pain presentations of women with forms of chronic vulvar pain (ie, vulvodynia) One hundred and seventy-seven women with five subtypes of vulvodynia completed an online questionnaire Groups were similar across several domains: participants experienced pain for many years during sexual and nonsexual activities, and pain was rated as moderate to severe However, several differences emerged when considering pain development, number of sexual partners, and treatment seeking This study illustrates how severe vulvodynia pain can be, regardless of subtype However, not all vulvodynia sufferers are alike, and distinctions between research and clinical practice are highlighted

Should Sexual Problems Be Included in the Internalizing Spectrum? A Comparison of Dimensional and Categorical Models.

Abstract: Preliminary research has suggested that sexual problems should be included in the internalizing spectrum alongside depressive and anxiety disorders. This study aimed to empirically examine and compare an extended internalizing spectrum model with a categorical framework model implied by the current nosological structure. Responses to an online survey from a community sample (n = 518) were analyzed to compare the fit of six alternative models of the relationship between sexual problems and depressive and anxiety disorders, separately for men and women. The best model for women (n = 336) was a dimensional spectrum model that included sexual arousal, orgasm, and pain difficulties in the internalizing spectrum. The results for men (n = 182) were less clear-cut: there were apparent categorical relationships for a small group (n = 8), and the spectrum model showed a good fit for 96% of the sample. These findings are consistent with a nosology that maintains discrete disorders and diagnostic chapters while recog...

Treating Out of Control Sexual Behavior: Rethinking Sex Addiction.

Abstract: Treating Out of Control Sexual Behavior: Rethinking Sex Addiction, by Douglas Braun-Harvey and Michael A. Vigorito. New York, NY: Springer Publishing Company, 2015, 435 pages, $85.00 (paperback), $...

A Case of Comorbid Persistent Genital Arousal Disorder and Premature Ejaculation: Killing Two Birds With One Stone.

Abstract: Persistent genital arousal disorder (PGAD) was first described in 2001 by Leiblum and Nathan in females and is characterized by five diagnostic criteria, including (1) the persistence of genital arousal for an extended period of time, (2) unresolved after one or more orgasms, (3) unrelated to subjective sexual desire or feelings, (4) experienced as intrusive and unwanted, and (5) causes distress. Concordant with the theory of a nervous-system dysfunction including neuropathy (Waldinger et al., 2011), alleviation of symptoms has been observed in response to treatment with topiramate (Ramic, 2013), pregabalin (Philippsohn & Kruger, 2012), duloxetine (Philippsohn & Kruger, 2012), and botulinum toxin (Nazik et al., 2014), although all these cases were restricted to women. Here, we report the successful treatment of a comorbid lifelong premature ejaculation (PE) and PGAD in an otherwise healthy man using only one drug.

Relational Intimacy and Sexual Frequency: A Correlation or a Cause? A Clinical Study of Heterosexual Married Women

Abstract: Researchers and practitioners have noted the importance of using clinical samples in sex therapy research. This study investigated the relationship between perceived levels of marital intimacy, sexual frequency, and sexual functioning among heterosexual married women. A clinical sample of 67 women completed the Couples Satisfaction Index (CSI), the Miller Social Intimacy Test (MSI), the Sexual Satisfaction Scale for Women (SSS-W), the Inclusion of the Other in the Self Scale (IOS), and the Female Sexual Functioning Index (FSFI-6). Data analyses revealed that marital intimacy acted as a predictor in univariate relationships on sexual frequency and sexual functioning but did not act as a mediator on sexual frequency and sexual functioning. Overall, these findings may further the discussion in the treatment of relational intimacy, sexual desire discrepancy, and female sexual dysfunction.

Couple Resilience: Emerging Perspectives

Abstract: sexual behavior and, thus, it is difficult to follow how personal distress is not an integral concept. While the authors acknowledge that feelings of distress can motivate an individual toward sexual health, it may be necessary to retain personal distress, not necessarily as a clinical threshold, but as a consideration over and above motivation as it captures real psychological realities. Moreover, given the authors’ move away from the addiction or psychosexual disorder model and given the field’s inherent values-laden context, the tone of some sections seems to promote certain sexual values. Of course, when advancing a vision of sexual health, it is recognizably difficult not to engage in a values-informed tone. Nonetheless, it is important to note that these issues are only minimal and, in general, the book is very well written and seamlessly integrates rigorous research with clinical experience. Overall, Braun-Harvey and Vigorito’s exposition of problematic sexual behavior is excellent. By effectively communicating an alternative to the predominant models, the authors have crafted a book of relevance to therapists engaged in the treatment of OCSB. In advancing intriguing viewpoints on problematic sexual behavior and clearly articulating an innovative treatment model, Treating Out of Control Sexual Behavior is highly recommended for use by therapists.

Sex Outside the Lines: Authentic Sexuality in a Sexually Dysfunctional Culture

Abstract: Sex Outside the Lines: Authentic Sexuality in a Sexually Dysfunctional Culture, by Chris Donaghue. Dallas, TX: BenBella Books, Inc., 2015, 244 pages, $24.95 (hardback).Sex Outside the Lines is Chri...