THE AMERICAN ACADEMY OF CLINICAL SEXOLOGISTS EROTOLOGY AND THE STUDY OF DESIRE AND AROUSAL Author Peggy R. Lipford McKeal, Ph.D. Research and Collaboration John F. Wirth Melissa Vinson A DISSERTATION SUBMITTED TO THE FACULTY OF THE AMERICAN ACADEMY OF CLINICAL SEXOLOGISTS AT MAIMONIDES UNIVERSITY IN PARTIAL FULFILLMENT OF THE RQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHY BY JOHN F. WIRTH MELISSA VINSON FT/ LAUDERDALE, FLORIDA AUGUST 2008 Copyright © by Peggy R. Lipford McKeal All rights reserved DISSERTATION APPROVAL This dissertation submitted by John. F. Wirth and Melissa Vinson has been read and approved by three faculty members of the American Academy of Clinical Sexologists. The final copies have been examined by the Dissertation Committee and the signatures that appear here verify the fact that any necessary changes have been incorporated and that the dissertation is now given the final approval with reference to content, form and mechanical accuracy. The dissertation is therefore accepted in partial fulfillment of the requirements for the degree of Doctor of Philosophy. Signature Date August 2008 William A. Granzig, Ph.D. August 2008 Peggy R. Lipford McKeal, Ph.D. August 2008 Rhonda Fine, Ph.D. Erotology and the Study of Desire and Arousal It is the responsibility of the field of sexology to more clearly define what we mean by erotology, ecotherapy, and ecospirituality and its use in therapy regarding desire and arousal. As an agent of change in society, sexology must educate society about new thoughts in the field and the possibility of new ways to enhance understanding and ease with sexual topics. Archaic thought and definition can no longer be used if society is to move forward in intelligent, humanitarian, and non-bigoted ideas about the sexual rights and actions of others. If sexology is a mirror of the society we live in, then the study of sex and the education taught from that study must keep up with the vast amount of information available to the human race in the 21 st century. Sexology must share its unique and far reaching understanding and ideas on a level equal to the advanced therapist in sex therapy practices, the medical community and society at large. The intelligent, information seeking public will accept no less from those who are in this helping field, and it is a duty to society at large to share learned truths. Philosophically speaking, a look at the definitions of erotology and desire reminds us of the uniqueness of society. Erotology has several different definitions that can be found with a similar theme. It has been described as the study of erotic expression in any form of representation which seeks to sexually arouse its audience (Erotic Media Experts LLC 2005) the scholarly study of sexual love, including erotica and pornography (Farlex 2004) and as the study and description of sexual love and love making (Merriam-Webster Incorporated 2007). Parts of these different interpretations or definitions acknowledge that the study of erotology is similar to the study of arousal and desire. The various definitions suggest that erotology focuses on erotic expressions in different forms, which has the ultimate goal of evoking a response. An online sex dictionary presents an alternative definition calling erotology a euphemism for pornography. This shows that the definition of erotology varies depending on your source of reference (Farlex 2008). In the relationship between erotology and desire, the question remains, how does a person begin to have desire, how does that person become aroused, is there a way of defining what make desire happen, and are there tools to help increase, promote, encourage and/or enhance desire? If there are tools, what are they, and what techniques and skills are required? The study of Eros has always strived to answer these questions with varying degrees of success. Attempts to address arousal and desire, increasing it, or the lack of it in individuals and couples has lead to professional diagnostic labels and criteria that sometimes lead to help, but often limit improvement in sexual functioning for the individual. These attempts have also lead to a plethora of medical advice, surgeries, devices, pharmacology, alternative supplements, techniques, media, toys and aids, and multiple theories on what will work, but ultimately may not. Certainly, labels and diagnostic criteria, medicines and vitamins, plus teaching behavioral skills and techniques for problems, while attempting to give information to society, may lead to more confusion for specific individuals looking for answers. And individuals are aggressively seeking solutions in many arenas. There have been numerous theories on phases of arousal in humans. Masters and Johnson’s theory and extensive research is well known to experienced clinicians in the field. In her book The Nature and Evolution of Female Sexuality, Mary Jane Sherfey, M.D. writes extensively about differences in female response and her theories regarding arousal, vaginal insensitivity, and potential for multiple orgasms. She includes numerous diagrams of anatomy to educate the reader. According to her the four phases of arousal in women are presented as: Phase I, Excitement. Duration: several minutes to hours. Phase II, Plateau. Duration: 30 seconds to 3 minutes. Phase III, Orgasm. Duration: 3-15 seconds. Phase IV, Resolution. Duration: with orgasm, 10-25 minutes; with no orgasm, several hours. (Sherfey 1972) Her chart, presented over four pages, shows these four stages along with nine parts of the female anatomy and how they progress through the phases of arousal. The body parts include the skin, breasts, clitoris, labia majora, labia minora, greater vestibular glands, the vagina in the upper 2/3 rd and lower 1/3 rd , the uterus and perineal body, rectum and others. While not being presented in a chart, comparisons and similarities are listed between the sexual response cycles of women and men. According to the Sherfey, the response cycle in men may be divided into the same four phases as in women, although they are less well defined. The fact that women do not have a refractory period is introduced, as well as a woman’s ability to have multiple orgasms. The refractory period is mentioned but apparently is not considered a phase in the sexual response cycle of men. She includes information that a man may delay ejaculation purposefully, and that many young men are capable of repetitive ejaculations. However, for men, after the initial ejaculation, the erectile chambers return to plateau level refractory period. Sadly, there is no mention of desire, cathexsis, eroticism or what happens first in the phase-one-desire that leads to acts and interest in sexual contact. Historically, no researchers have adequately defined this preemptive what-happens-first phase: desire. Patients, when asking for help clearly state, “I have low libido, no interest in sex.” Problems with desire have been diagnosable, according to the medical community, as a consequence of sexual dysfunction. There are twenty three diagnostic labels for sexually based disorders in the Diagnostic and Statistical Manual of Mental Disorders. (DSM IV 2000) Sexual desire disorders head the list. An online article entitled “Sexual Dysfunction; Treatment” reports that treatment for sexual dysfunction depends on the cause of the problem. If the cause is determined to be physical then medical treatment may be the focus for correcting the underlying disorder that is contributing to or producing the sexual disorder. If the cause is determined to be psychological, treatment consists of counseling and therapy. If necessary, treatment can also include a combination of medical, behavioral, and psychological approaches. The experienced sex therapist knows that society has been bombarded with new drugs that can enhance erection, or reduce premature ejaculation for males, and hormone replacement or addition that may help to increase desire in males or females. Pharmaceutical companies with an eye on gigantic sales are aware that there is a component of interest that they have not captured, and there is a rush to develop an inhaler, a pill or a cream that will magically make phase-one-interest happen. As the experienced sexologist is aware, and society is beginning to learn, drug therapy does not always fix the problem. Hormone levels can be adjusted, vasocongestion ability in place, yet interest or success in sexual interaction remains disappointingly low. Sometimes, treatment may need to be behavioral techniques that will help retrain the mind and thought process, or help shift the focus to problems that exist in the relationship and ultimately deter successful and passionate surrender in sexual interaction. For example, if there is loss of desire due to relationship issues, introducing changes in the environment, timing, lovemaking techniques or changes in foreplay may help induce desire. With arousal disorder, the use of toys and vibrators may aid circulation. A warm bath and a massage from a partner may promote circulation and relaxation, and a more intimate emotional connection. (NWHRC Health Center 2005) Techniques of sensate focus exercises have been known to work with some patients because of education attained regarding a partner’s needs, and also the promotion of intimacy without pressure to perform. However, these same behavioral and sensate focus exercises, aimed to reduce stress and sexual performance anxiety, and sexually educate couples, instead can often focus couples on existing and more serious relationship problems of which they were unaware. This can result in less sexual success for troubled patients, even in the most experienced sex therapist offices. Experienced sexologists understand the impact of conflicts, boredom, or unhappiness with partners and that these and other types of sexual dysfunction can contribute to desire disorders. Poor communication between partners is often present with all sexual dysfunction, desire and arousal problems. Members of society seeking information, education, and sex therapy may be limited in understanding that learning to communicate, resolving conflict, and dealing with negative emotions are positive points that can enhance sexual relationships.