The high incidence of divorce and marital breakdown in South Africa warrants attention and organised prevention. There is no correlation between this high divorce rate and existing facilities or utilisation of these facilities. For the past fifteen years the writer has been involved in training of Marriage Guidance Counsellors and treatment of marital couples in distress. During this time limited facilities, the inability of some couples to utilise existing facilities and the resultant family disruption has become evident. In an effort to assess the most important needs of couples in distress and the ability of consultants in the helping professions to assist these couples this research was initiated. Previous findings that sexual dissatisfaction is one of the main reasons of marital breakdown has been confirmed as well as the fact that it is often a mere symptom of various difficulties and poor marital communication. It was also found that different needs regarding sex education and sex therapy exist in our multicultural society and that thorough recognition of these specific needs is required to offer meaningful assistance. Following this multicultural evaluative investigation which included a multi-disciplinary enquiry, data was summarised and a tentative training programme suggested. Final conclusions are not provided. Qualitative data to assist the practitioner has been summarised and a continuous feedback loop of evaluation and improved programme planning initiated in accordance with the requirements of illuminative action research. / Thesis (Ph.D.)-University of Durban-Westville, 1984.

O transexualismo é caracterizado pelo desejo irreversível de viver e ser aceito como pertencente ao sexo oposto ao seu sexo biológico. Os transexuais masculinos (feminino para masculino) utilizam cronicamente hormônios androgênicos para promover alterações nas características sexuais secundárias compatíveis com o sexo de identidade, correspondendo à terapia hormonal cruzada.A testosterona é o principal hormônio usado na terapia hormonal cruzada desta população. Embora seja considerada segura, quando utilizada em doses adequadas, poucos estudos estão disponíveis na literatura a respeito dos efeitos da testosterona nessa população específica, além de incluir tamanhos amostrais pequenos. Assim, os objetivos desta dissertação foram os de revisar de forma sistemática a literatura a respeito dos efeitos do tratamento comtestosterona sobre o perfil clínico, metabólico, hematológico, lipídico e hepático de indivíduos transexuais masculinos.Nesta revisão sistemática e meta-análise, buscaram-se estudos publicados até maio de 2016 nas bases de dados Medline (PUBMED) and EMBASE. Foram incluídos estudos que relatassem intervenções com qualquer dose de testosterona e que apresentassem dados comparando variáveis clínicase metabólicas antes e depois do tratamento Para a meta-análise, somente artigos que tivessem analisado os efeitos do tratamento com undecanoato de testosterona por 12 meses foram incluídos. Desta forma, o tamanho do efeito foi calculado como alteração em 12 meses em relação ao valor médio basal. A busca resultou em 391 artigos potencialmente elegíveis. Destes, 13 alcançaram os critérios de eligibilidade e foram incluídos na revisão sistemática. Três foram elegíveis para a meta-análise. A qualidade destes estudos de acordo com a escala de Newcastle-Ottawa Scale foi boa. O tratamento com undecanoato de testosterona promoveu um significativo aumento nos níveis séricos de testosterona (tamanho do efeito 6.18, IC 95%: 4.59 à 7.76), hematócrito(4.80, IC95%: 4.06 à 5.54), hemoglobina(1.54, IC95%: 1.10 à 1.98), e pressão sistólica (4.74, IC 95%: 2.15 à7.33). Em conclusão, os resultados deste trabalho sugerem que o tratamento comundecanoato de testosteronaé efetivo e embora aumente significativamente hematócrito, hemoglobina e pressão sistólica no primeiroano de tratamento de homens transgêneros, estes achados são clinicamente aceitáveis evidenciando segurança deste tratamento. / Transsexualism is characterized by the irreversible desire to live and be accepted as belonging to the opposite sex to its biological sex. Male transsexuals (female to male) chronically use androgenic hormones to promote changes in secondary sexual characteristics compatible with gender identity, corresponding to cross-sex hormone therapy. Testosterone is the main hormone used in cross-hormone therapy in this population. Although it is considered safe, when used in adequate doses, few studies are available in the literature regarding the effects of testosterone in this specific population, in addition to including small sample sizes. Thus, the objectives of this dissertation were to systematically review the literature regarding the effects of testosterone treatment on the clinical, metabolic, hematological, lipid and hepatic profile of male transsexual individuals. In this systematic review and meta-analysis, studies were published until May 2016 in the Medline (PUBMED) and EMBASE databases. We included studies that reported interventions with any dose of testosterone and that presented data comparing clinical and metabolic variables before and after treatment For the meta-analysis, only articles that had analyzed the effects of treatment with testosterone undecanoate for 12 months were included. In this way, the effect size was calculated as change in 12 months in relation to the baseline mean value. Search resulted in 391 potentially eligible articles. Of these, 13 met the eligibility criteria and were included in the systematic review. Three were eligible for the meta-analysis. The quality of these studies according to the Newcastle-Ottawa Scale scale was good. Treatment with testosterone undecanoate promoted a significant increase in serum testosterone levels (effect size 6.18, 95% CI: 4.59 to 7.76), hematocrit (4.80, 95% CI: 4.06 to 5.54), hemoglobin (1.54, 95%: 1.10 to 1.98), and systolic pressure (4.74, 95% CI: 2.15 to 7.33). In conclusion, the results of this work suggest that testosterone undecanoate treatment is effective and although it significantly increases hematocrit, hemoglobin and systolic pressure in the first year of treatment of transgender men, these findings are clinically acceptable, evidencing the safety of this treatment.

O transexualismo é caracterizado pelo desejo irreversível de viver e ser aceito como pertencente ao sexo oposto ao seu sexo biológico. Os transexuais masculinos (feminino para masculino) utilizam cronicamente hormônios androgênicos para promover alterações nas características sexuais secundárias compatíveis com o sexo de identidade, correspondendo à terapia hormonal cruzada.A testosterona é o principal hormônio usado na terapia hormonal cruzada desta população. Embora seja considerada segura, quando utilizada em doses adequadas, poucos estudos estão disponíveis na literatura a respeito dos efeitos da testosterona nessa população específica, além de incluir tamanhos amostrais pequenos. Assim, os objetivos desta dissertação foram os de revisar de forma sistemática a literatura a respeito dos efeitos do tratamento comtestosterona sobre o perfil clínico, metabólico, hematológico, lipídico e hepático de indivíduos transexuais masculinos.Nesta revisão sistemática e meta-análise, buscaram-se estudos publicados até maio de 2016 nas bases de dados Medline (PUBMED) and EMBASE. Foram incluídos estudos que relatassem intervenções com qualquer dose de testosterona e que apresentassem dados comparando variáveis clínicase metabólicas antes e depois do tratamento Para a meta-análise, somente artigos que tivessem analisado os efeitos do tratamento com undecanoato de testosterona por 12 meses foram incluídos. Desta forma, o tamanho do efeito foi calculado como alteração em 12 meses em relação ao valor médio basal. A busca resultou em 391 artigos potencialmente elegíveis. Destes, 13 alcançaram os critérios de eligibilidade e foram incluídos na revisão sistemática. Três foram elegíveis para a meta-análise. A qualidade destes estudos de acordo com a escala de Newcastle-Ottawa Scale foi boa. O tratamento com undecanoato de testosterona promoveu um significativo aumento nos níveis séricos de testosterona (tamanho do efeito 6.18, IC 95%: 4.59 à 7.76), hematócrito(4.80, IC95%: 4.06 à 5.54), hemoglobina(1.54, IC95%: 1.10 à 1.98), e pressão sistólica (4.74, IC 95%: 2.15 à7.33). Em conclusão, os resultados deste trabalho sugerem que o tratamento comundecanoato de testosteronaé efetivo e embora aumente significativamente hematócrito, hemoglobina e pressão sistólica no primeiroano de tratamento de homens transgêneros, estes achados são clinicamente aceitáveis evidenciando segurança deste tratamento. / Transsexualism is characterized by the irreversible desire to live and be accepted as belonging to the opposite sex to its biological sex. Male transsexuals (female to male) chronically use androgenic hormones to promote changes in secondary sexual characteristics compatible with gender identity, corresponding to cross-sex hormone therapy. Testosterone is the main hormone used in cross-hormone therapy in this population. Although it is considered safe, when used in adequate doses, few studies are available in the literature regarding the effects of testosterone in this specific population, in addition to including small sample sizes. Thus, the objectives of this dissertation were to systematically review the literature regarding the effects of testosterone treatment on the clinical, metabolic, hematological, lipid and hepatic profile of male transsexual individuals. In this systematic review and meta-analysis, studies were published until May 2016 in the Medline (PUBMED) and EMBASE databases. We included studies that reported interventions with any dose of testosterone and that presented data comparing clinical and metabolic variables before and after treatment For the meta-analysis, only articles that had analyzed the effects of treatment with testosterone undecanoate for 12 months were included. In this way, the effect size was calculated as change in 12 months in relation to the baseline mean value. Search resulted in 391 potentially eligible articles. Of these, 13 met the eligibility criteria and were included in the systematic review. Three were eligible for the meta-analysis. The quality of these studies according to the Newcastle-Ottawa Scale scale was good. Treatment with testosterone undecanoate promoted a significant increase in serum testosterone levels (effect size 6.18, 95% CI: 4.59 to 7.76), hematocrit (4.80, 95% CI: 4.06 to 5.54), hemoglobin (1.54, 95%: 1.10 to 1.98), and systolic pressure (4.74, 95% CI: 2.15 to 7.33). In conclusion, the results of this work suggest that testosterone undecanoate treatment is effective and although it significantly increases hematocrit, hemoglobin and systolic pressure in the first year of treatment of transgender men, these findings are clinically acceptable, evidencing the safety of this treatment.

Counselors and other mental health professionals lack training on healthy sexuality and sexual identity development (SID). To begin to construct a comprehensive model of SID that can be used in counseling and counselor education, I conducted an exploratory study utilizing a grounded theory approach to collect and analyze SID stories from a purposive sample of eight adults from the Dallas-Fort Worth, Texas area: four male and four female; seven White Caucasian-American and one Asian American; and self-identified as two gay, one lesbian, three heterosexual, and two sexually fluid. Participants elucidated a process model of the sexual-self that incorporated biological, psychological, social, cultural, and spiritual factors. Emergent themes included discovering, distinguishing, placing boundaries around, differentiating, and integrating the sexual-self. This preliminary model advanced a more holistic understanding of SID that counselors and other mental health professionals, educators, and researchers may find useful within their respective disciplines.

<p dir="ltr">Patient-clinician communication about sexual health facilitates trust, the reporting of clinical symptoms, and improves sexual quality of life (Reese et al., 2017). Unfortunately, very little is known about the spectrum of sexual interests and behaviors throughout a lifespan significantly limiting the information shared during those conversations (Hughes & Wittmann, 2014). The American Psychiatric Association (2022) assumed responsibility and detailed when a sexual interest becomes problematic. However, criteria for psychosexual diagnoses are vague and frequently do not have empirical evidence to demonstrate their existence (Moser, 2019; Randall & Sprott, 2016). The following research used the Delphi method to operationally define and differentiate between a variety of psychosexual concepts. Through this pilot study, a panel of 13 experts defined, categorized, and classified a series of terms as well as an array of non-normative sexual behaviors. Results were analyzed through the lens of queer theory and indicated that while expert consensus can be reached, further research is necessary to systematically destigmatize a wider variety of sexual interests.</p>

Thesis (M.S.W.) - Carleton University, 2007. / Includes bibliographical references (p. 133-146). Also available in electronic format on the Internet.

In this thesis I explore the social construction of sexuality and sexual dysfunction. Interviews were undertaken with 20 sex therapists practising in Aotearoa/New Zealand in order to elicit accounts of contemporary sex therapy practice in the local context. Using a feminist poststructuralist lens, I explicate and critically examine the dominant discourses informing the construction of sex therapy, and heterosexual sexual relations, and what these discourses enable and constrain. I draw attention to some of the assumptions embedded in the construction of the sexual dysfunctions in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, APA, 2000), and in accounts of sex therapy practice, examining the ways in which these are based on taken-for-granted norms of (hetero)sexuality and highlighting the differently enabled gendered sexual subjectivities they (re)produce. Although there are nine sexual dysfunctions identified in the DSM-IV-TR, all of which I briefly outline in Chapter Four, I restrict my focus in the analytical chapters to the conceptualisation and treatment of vaginismus, orgasm difficulties in women, discrepancies in desire and, relatedly, the gendering of desire through powerful sociocultural discourses and representations. I pay particular attention to the implications of these for heterosexual women’s sexuality. I also explore some of the generic concepts that dominate the construction of therapy at a broader level than that of sex therapy alone, arguing that while these offer some useful ways of framing therapy they also constrain therapy practice in important ways. Through a critical review of the sex therapy literature and accounts of practice from those interviewed, I contend that contemporary sex therapy tends to reify dominant cultural and sexological norms rather than challenge them. My analyses show that the dominant discourses informing constructions of sex therapy and heterosexual sexual relations produce particular types of sex as normal whilst marginalizing sexual acts or practices that fall outside of such restrictive parameters. In particular, I argue that the genital-coital-orgasm construct that is hegemonic within sex therapy restricts possibilities for alternative erotic pleasures and possibilities amongst heterosexuals whilst contributing to the invisibilization of sexual identities other than heterosexual. Accounts of sex therapy practice that were able to contest such framings are also highlighted. Because these came from sex therapists drawing on radical feminist or feminist poststructuralist discourses, I suggest that these discourses offer important possibilities for a deconstructive (sex) therapy practice that is able to challenge an often inequitable sexual status quo. Attention is also drawn to the significant constraints which act to restrict clients’ choices and possibilities for sex therapists to practise in more critically questioning ways. I conclude this thesis with an ‘invitation to reflection’ where I briefly discuss some deconstructive approaches that I have found useful for developing ongoing reflexive analysis of my own taken-for-granted assumptions in the area of sexuality, and for aiding my thinking about therapeutic practices that support my political and theoretical commitments and that attend to some of the issues outlined in this thesis. / Whole document restricted, but available by request, use the feedback form to request access.

In this thesis I explore the social construction of sexuality and sexual dysfunction. Interviews were undertaken with 20 sex therapists practising in Aotearoa/New Zealand in order to elicit accounts of contemporary sex therapy practice in the local context. Using a feminist poststructuralist lens, I explicate and critically examine the dominant discourses informing the construction of sex therapy, and heterosexual sexual relations, and what these discourses enable and constrain. I draw attention to some of the assumptions embedded in the construction of the sexual dysfunctions in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, APA, 2000), and in accounts of sex therapy practice, examining the ways in which these are based on taken-for-granted norms of (hetero)sexuality and highlighting the differently enabled gendered sexual subjectivities they (re)produce. Although there are nine sexual dysfunctions identified in the DSM-IV-TR, all of which I briefly outline in Chapter Four, I restrict my focus in the analytical chapters to the conceptualisation and treatment of vaginismus, orgasm difficulties in women, discrepancies in desire and, relatedly, the gendering of desire through powerful sociocultural discourses and representations. I pay particular attention to the implications of these for heterosexual women’s sexuality. I also explore some of the generic concepts that dominate the construction of therapy at a broader level than that of sex therapy alone, arguing that while these offer some useful ways of framing therapy they also constrain therapy practice in important ways. Through a critical review of the sex therapy literature and accounts of practice from those interviewed, I contend that contemporary sex therapy tends to reify dominant cultural and sexological norms rather than challenge them. My analyses show that the dominant discourses informing constructions of sex therapy and heterosexual sexual relations produce particular types of sex as normal whilst marginalizing sexual acts or practices that fall outside of such restrictive parameters. In particular, I argue that the genital-coital-orgasm construct that is hegemonic within sex therapy restricts possibilities for alternative erotic pleasures and possibilities amongst heterosexuals whilst contributing to the invisibilization of sexual identities other than heterosexual. Accounts of sex therapy practice that were able to contest such framings are also highlighted. Because these came from sex therapists drawing on radical feminist or feminist poststructuralist discourses, I suggest that these discourses offer important possibilities for a deconstructive (sex) therapy practice that is able to challenge an often inequitable sexual status quo. Attention is also drawn to the significant constraints which act to restrict clients’ choices and possibilities for sex therapists to practise in more critically questioning ways. I conclude this thesis with an ‘invitation to reflection’ where I briefly discuss some deconstructive approaches that I have found useful for developing ongoing reflexive analysis of my own taken-for-granted assumptions in the area of sexuality, and for aiding my thinking about therapeutic practices that support my political and theoretical commitments and that attend to some of the issues outlined in this thesis. / Whole document restricted, but available by request, use the feedback form to request access.

In this thesis I explore the social construction of sexuality and sexual dysfunction. Interviews were undertaken with 20 sex therapists practising in Aotearoa/New Zealand in order to elicit accounts of contemporary sex therapy practice in the local context. Using a feminist poststructuralist lens, I explicate and critically examine the dominant discourses informing the construction of sex therapy, and heterosexual sexual relations, and what these discourses enable and constrain. I draw attention to some of the assumptions embedded in the construction of the sexual dysfunctions in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, APA, 2000), and in accounts of sex therapy practice, examining the ways in which these are based on taken-for-granted norms of (hetero)sexuality and highlighting the differently enabled gendered sexual subjectivities they (re)produce. Although there are nine sexual dysfunctions identified in the DSM-IV-TR, all of which I briefly outline in Chapter Four, I restrict my focus in the analytical chapters to the conceptualisation and treatment of vaginismus, orgasm difficulties in women, discrepancies in desire and, relatedly, the gendering of desire through powerful sociocultural discourses and representations. I pay particular attention to the implications of these for heterosexual women’s sexuality. I also explore some of the generic concepts that dominate the construction of therapy at a broader level than that of sex therapy alone, arguing that while these offer some useful ways of framing therapy they also constrain therapy practice in important ways. Through a critical review of the sex therapy literature and accounts of practice from those interviewed, I contend that contemporary sex therapy tends to reify dominant cultural and sexological norms rather than challenge them. My analyses show that the dominant discourses informing constructions of sex therapy and heterosexual sexual relations produce particular types of sex as normal whilst marginalizing sexual acts or practices that fall outside of such restrictive parameters. In particular, I argue that the genital-coital-orgasm construct that is hegemonic within sex therapy restricts possibilities for alternative erotic pleasures and possibilities amongst heterosexuals whilst contributing to the invisibilization of sexual identities other than heterosexual. Accounts of sex therapy practice that were able to contest such framings are also highlighted. Because these came from sex therapists drawing on radical feminist or feminist poststructuralist discourses, I suggest that these discourses offer important possibilities for a deconstructive (sex) therapy practice that is able to challenge an often inequitable sexual status quo. Attention is also drawn to the significant constraints which act to restrict clients’ choices and possibilities for sex therapists to practise in more critically questioning ways. I conclude this thesis with an ‘invitation to reflection’ where I briefly discuss some deconstructive approaches that I have found useful for developing ongoing reflexive analysis of my own taken-for-granted assumptions in the area of sexuality, and for aiding my thinking about therapeutic practices that support my political and theoretical commitments and that attend to some of the issues outlined in this thesis. / Whole document restricted, but available by request, use the feedback form to request access.

In this thesis I explore the social construction of sexuality and sexual dysfunction. Interviews were undertaken with 20 sex therapists practising in Aotearoa/New Zealand in order to elicit accounts of contemporary sex therapy practice in the local context. Using a feminist poststructuralist lens, I explicate and critically examine the dominant discourses informing the construction of sex therapy, and heterosexual sexual relations, and what these discourses enable and constrain. I draw attention to some of the assumptions embedded in the construction of the sexual dysfunctions in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, APA, 2000), and in accounts of sex therapy practice, examining the ways in which these are based on taken-for-granted norms of (hetero)sexuality and highlighting the differently enabled gendered sexual subjectivities they (re)produce. Although there are nine sexual dysfunctions identified in the DSM-IV-TR, all of which I briefly outline in Chapter Four, I restrict my focus in the analytical chapters to the conceptualisation and treatment of vaginismus, orgasm difficulties in women, discrepancies in desire and, relatedly, the gendering of desire through powerful sociocultural discourses and representations. I pay particular attention to the implications of these for heterosexual women’s sexuality. I also explore some of the generic concepts that dominate the construction of therapy at a broader level than that of sex therapy alone, arguing that while these offer some useful ways of framing therapy they also constrain therapy practice in important ways. Through a critical review of the sex therapy literature and accounts of practice from those interviewed, I contend that contemporary sex therapy tends to reify dominant cultural and sexological norms rather than challenge them. My analyses show that the dominant discourses informing constructions of sex therapy and heterosexual sexual relations produce particular types of sex as normal whilst marginalizing sexual acts or practices that fall outside of such restrictive parameters. In particular, I argue that the genital-coital-orgasm construct that is hegemonic within sex therapy restricts possibilities for alternative erotic pleasures and possibilities amongst heterosexuals whilst contributing to the invisibilization of sexual identities other than heterosexual. Accounts of sex therapy practice that were able to contest such framings are also highlighted. Because these came from sex therapists drawing on radical feminist or feminist poststructuralist discourses, I suggest that these discourses offer important possibilities for a deconstructive (sex) therapy practice that is able to challenge an often inequitable sexual status quo. Attention is also drawn to the significant constraints which act to restrict clients’ choices and possibilities for sex therapists to practise in more critically questioning ways. I conclude this thesis with an ‘invitation to reflection’ where I briefly discuss some deconstructive approaches that I have found useful for developing ongoing reflexive analysis of my own taken-for-granted assumptions in the area of sexuality, and for aiding my thinking about therapeutic practices that support my political and theoretical commitments and that attend to some of the issues outlined in this thesis. / Whole document restricted, but available by request, use the feedback form to request access.