Contemporary sex therapy, as a social location within which interventions are made in the field of human sexuality, constitutes a terminal point through which discourses of race, ethnicity, gender and sexuality interface and become meditated. It is also a site in which the particular outcomes of this mediation can be expected to have a significant bearing upon clients who, as social and sexual subjects, carry diverse racialised and ethnicised identities. Though a substantial literature exists pertaining to classical sexology, relatively little is sociologically known about contemporary sex therapy within the UK, and nothing is known of the manner in which discourses of race and ethnicity operate within the field. This exploratory research examines the discourses produced by sex therapists (both in talk and text) regarding the nature and significance of race and ethnicity, and the substantive qualities, significance and effects attributed to these in shaping patterns of human sexuality, sexual dysfunction and sex therapy. The aim is to analyse and account for these discourses as the products of underlying cognitive models of race, ethnicity, gender and sexuality, as these have evolved within the particular social location of sex therapy (as a deposit of a broader racialised and ethnicised social consciousness), and formed the basis of an active utilisation by therapists in the pursuit of `preferred renditions' of sex therapy practice. The thesis also aims to explore sex therapists' accounts of the necessary and sufficient conditions for the achievement of effective, equitable and non-oppressive therapeutic intervention in a context of racial and ethnic diversity. The research supports a rendition of sex therapy as a complex constituency, struggling to make sense of the nature and significance of race and ethnicity as sources of difference, and as dimensions of the social subject. Liberal-humanistic, biological-essentialist and versions of ethnic essentialism compete and coalesce as the primary elements of sex therapists' constructions of race and ethnicity as dimensions of the gendered sexual subject, informing their accounts of the necessary and sufficient conditions for the delivery of appropriate, sensitive and non-oppressive praxis.

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The most commonly reported sexual concerns for women are low desire and orgasm difficulties (Laumann, Paik & Rosen, 1999; Laumann et al., 2005). Previous research indicates that women with sexual problems may have different reasons for engaging in sex than women with healthy sexual functioning (Giles & McCabe, 2009; Sand & Fisher, 2007). The current study investigated whether motivations for sex differed by levels of sexual functioning overall and specifically among women with and without problems with sexual desire or orgasm. Seven hundred and eight heterosexual women completed an online questionnaire assessing reasons for sex and sexual functioning. Women with sexual functioning concerns were more likely to endorse insecurity reasons for sex, while women without were more likely to endorse physical reasons for sex. Women experiencing low desire were less likely to endorse emotional and physical reasons for sex. Women experiencing orgasm difficulties were more likely to endorse insecurity reasons. The limitations and implications of the results are discussed.

Background: Multimodal cancer treatments are often associated with sexual problems. Identifying patients with sexual problems could help further elucidate serious issues with their sexuality and thus promote or maintain patients’ sexual health. We aimed to assess the occurrence of sexual problems in patients across different tumor locations and to explore associated sociodemographic, medical and psychosocial factors. Methods: We included 3,677 cancer patients (mean age 58 years, age range 18– 75 years, 51.4% women) from a large epidemiological multicenter study in Germany on average 13.5 months after cancer diagnosis. The occurrence and frequency of sexual problems were assessed via a binary item on the problem checklist of the Distress Thermometer (DT). Controlled associations of these problems with sociodemographic, medical and psychosocial factors including distress (DT), anxiety (GAD-7), depression (PHQ-9), quality of life (EORTC-QLQ-C30), and social support (SSUK-8) are analyzed using logistic regression analysis. Results: We found that 31.8% of patients reported sexual problems, with a significant higher proportion in men (40.5%) compared to women (23.7%), OR 2.35, 95% CI [1.80– 3.07] and a higher proportion in patients with a partner (35.6%) compared to those without a partner (3.5%), OR 2.83, 95% CI [2.17–3.70]. Tumor location was associated with occurrence of sexual problems: patients with cancer, affecting the male genital organs had the highest chance for sexual problems, OR 2.65, 95% CI [1.18–3.95]. There was no significant difference in the occurrence of sexual problems between age groups OR 0.99, 95% CI [2.13–3.53] and type of therapy (e.g., operation OR 0.91, 95% CI [0.72–1.15]). Sexual problems were further associated with elevated levels of anxiety, OR 1.05, 95% CI [1.02–1.10], less social support, OR 0.93, 95% CI [0.90–0.97] and lower quality of life in terms of impaired functioning (e.g., social function, OR 0.99, 95% CI [0.99–1.00]). Conclusions: Sexual problems are commonly reported by patients. Male patients and those living with a partner are more likely to report sexual problems. Sexual problems are associated with different aspects of well-being. The findings imply the practical relevance to screen for sexual problems among patients and identified groups that should be particularly monitored.

The analogue study was designed to extend previous research on clinical sex-role stereotyping of individual clients into the realm of marital counseling. The effects of clinician and couple sex-role style and type of marital problem on clinical judgements of couples was examined through ratings of four audiotaped couples constructed from two scripts depicting either couple financial or sexual problems. Each script produced both a stereotypical and counterstereotypical sex-role styled couple through reversal of spouse verbalizations. A sample of 40 (32 male, 8 female) practicing doctorate-level psychologists rated either two stereotypical or two counterstereotypical couples for level of maladjustment, need for treatment, and prognosis. Individual spouse ratings were also obtained to examine client gender effects.

An adult female sample of childhood sexual abuse survivors (N=467) were surveyed to determine whether internalized shame moderated the effects of sexual inhibited difficulties. Other variables such as severity, duration, and frequency of sexual abuse, as well as whether physical abuse was also part of their experience, were examined to determine their role in later sexual inhibition. It was predicted that there would be a significant positive relationship between 1) Scores on variables of physical abuse, severity of abuse, frequency of abuse, duration of abuse, identity of the perpetrator and scores on the variable of inhibited sexual difficulties; 2) Scores of internalized shame and scores of inhibited sexual difficulties and 3) Scores on variable of physical abuse, severity of abuse, frequency of abuse, duration of abuse, identity of the perpetrator and scores on the variables of internalized shame. Through Structural Equation Modeling using AMOS, the results indicated a statistically significant positive relationship between severity, frequency and inhibited sexual disturbances but found no direct relationship between physical abuse, the identity of the perpetrator, the duration of the abuse and inhibited sexual disturbances. Results also indicated that shame had a direct positive relationship to inhibited sexual disturbances. The third finding was that physical abuse and severity of abuse had a significant positive relationship with shame which implies that shame is a moderating variable for inhibited sexual disturbances in adult women survivors of childhood sexual abuse. Internalized shame may be an important factor for therapists to consider in helping survivors overcome sexual inhibition as a result of childhood sexual abuse. If a woman develops a shame-prone identity she may be at risk for experiencing inhibition in her sexuality.