1.4 Therapy

This is the phase in which the patient and his or her partner take affirmative action. The role of the care provider is to assist them in implementing the changes that they have jointly agreed. Once again, the key focus is the norms and values of the patient and partner. Although most knowledge regarding these norms and values has been gathered in the foregoing phases, they must once again be evaluated. One component of the therapy may be to encourage to touch and caress each other, exploring feelings and sensations which they will discuss with one another. In doing so, they may discover or rediscover parts of the body as erotic or erogenous zones, while any inhibitions become manifest and opened to discussion. Self-stimulation exercises can help the patient to experience what it is like to experience arousal in the new situation, and to discover what forms of stimulation are most effective. Focused erotic thoughts and fantasies will serve to displace distracting thoughts. The care provider may also recommend techniques and physical aids which will maximize stimulation. Pelvic floor exercises, for example, can help the patient to influence and enhance feelings of arousal at will. Hyperactivity of the pelvic floor musculature often plays a significant role in sexual arousal and response, with ‘pumping’ movements a common strategy used to promote arousal. However, this actually impedes the flow of blood to the genitals. The advice must then be to relax and devote greater attention to sexual sensations during intercourse itself. If there is actual dyspareunia or vaginismus, the female partner can be encouraged to use fingers and/or dilators of increasing size to assess and extend the possibility of penetration, although doing so without the necessary sexological advice and supervision is rarely fully effective.