Review of Chinese sex attitudes and applicability of sex therapy for chinese couples with sexual dysfunction

Although sex therapy techniques have widely been used to help Western couples with sexual dysfunction, there has been little research on the applicability of these techniques among Chinese couples. This article discusses the Chinese views and concepts of sex and sexual dysfunction in the past and present, culturally bound sexual problems, and gender role stereotypes. We suggest that with careful integration of the therapeutic techniques with Chinese sex concepts, sex therapy can be applied to Chinese Couples experiencing problems in sexual functioning.     

A study of sexual satisfaction and frequency of sex among Hong Kong Chinese couples

There have been several studies in Western societies on the causes and consequences of sexual satisfaction within marriage. Little is known, however about the marital sexual relationship in Chinese societies. Moreover, most published studies used married individuals rather than married couples as participants. The present study examined data from a well-established knowledge, attitude, and practice (KAP) survey of 1,124 Hong Kong Chinese couples on martial sexual relationship. A conceptual model was tested using structural equation modeling (SEM). Interest in sex was found to be the strongest predictor of both sexual satisfaction and frequency of sex for both husbands and wives. Among the sociodemographic variables, the following two were significantly associated with lower frequencies of sex: for wives, that of having a full-time job; and for husbands, the factor of age. Theoretical implications for research on the interplay among culture, marriage, and sex in non-Western societies are discussed.     

Sex therapy for couples: An italian perspective

This paper describes a sex therapy technique that utilizes three levels of intervention. The first level, which employs videotaping, is aimed at treating relationship conflicts and their expression. The second level is aimed at helping couples recover relationship and sexual skills. The third level is dedicated to direct treatment of the sexual dysfunction. Fifty‐five couples have been treated with this method, and the results suggest that this is a good strategy for the resolution of a sexual dysfunction, especially when couples are helped to reduce conflict in their relationship.     

The treatment of sexual problems in marital and family therapy

With the proliferation of new research data and clinical practice techniques for dealing with sexual dysfunction, many family and marital therapists whose patients express sexual complaints experience the need to integrate this knowledge into their practice. For many couples and therapists, the rapid treatment approaches to sexual difficulties are inappropriate or ineffectual, yet the current literature addresses itself to either sex therapyper se or marital therapy and rarely deals with an integration of the two. This paper presents guidelines for assessing the sexual difficulties in the context of the relationship and outlines techniques for addressing the sexual difficulties directly while maintaining a more traditional marital therapy approach.     

Sexual Portrait of Couples Seeking Relationship Therapy

This study sought to provide information about the sexual well‐being of 298 mixed‐sex couples seeking relationship therapy and determined the extent to which problems with sexual functioning and dyadic adjustment of both partners are associated with sexual satisfaction. Partners completed measures of dyadic adjustment, sexual satisfaction, and sexual functioning. Thirty percent of couples reported a clinically significant sexual problem. Compared to their male partners, the women were more likely to report a sexual problem as well as lower dyadic adjustment, sexual satisfaction, and overall sexual functioning. Path analysis indicated that relationship adjustment uniquely predicted individuals' own sexual satisfaction; problems in sexual functioning uniquely predicted own and partner sexual satisfaction. Findings underscore the need to address sexual problems in relationship therapy.     

The relationship between sex guilt and sexual desire in a community sample of Chinese and Euro-Canadian women

Many studies have documented significant differences in sexual desire between individuals of European and Chinese descent, but few have examined the mechanisms that underlie these differences. A recent study of university students found that sex guilt is one mechanism by which culture influences sexual desire among Chinese and Euro-Canadian women. The goal of this study was to examine whether sex guilt also mediates the relationship between ethnicity and sexual desire in a sample that is more representative of women in the general population. Euro-Canadian (n = 78; mean age = 42.1 years) and Chinese (n = 87; mean age = 42.8 years) women were recruited from the community. Euro-Canadian women reported greater sexual desire and less sex guilt. In the entire sample, sex guilt mediated the relationship between ethnicity and sexual desire such that the Chinese women reported greater sex guilt, which, in turn, was associated with lower sexual desire. Among the Chinese women, sex guilt mediated the relationship between mainstream acculturation (degree of Westernization) and sexual desire such that more Westernized Chinese women reported less sex guilt, which, in turn, was associated with greater sexual desire. These results support recent findings and further suggest that sex guilt may be one mechanism by which ethnicity affects sexual desire.     

The State of Sex Research in MFT and Family Studies Literature: A Seventeen‐Year Content Analysis

The ability to conceptualize and treat sexual problems has been widely accepted as a crucial skill to master the MFT training. However, clients’ sexual relationships are often ignored by clinicians because of a lack of experience or training, or personal discomfort. In this content analysis, we review sex and sex therapy research within MFT and family studies journals since the turn of the century. Of the 13,919 articles published within the 15 journals, 137 focused on sexuality or sex therapy. The articles were divided into five themes: sexual and relational health, sexual diversity, treatment and contributors of sexual dysfunction, sex therapy practices, and sexual education and development. Implications for clinical practices, sex therapy integration, and future research are discussed.     

The Couple Relationship as the Focus of Sex Therapy: The Integration of Sex Therapy Ideas and Techniques with Marital and Family Therapy

The marriage and family therapist needs basic information about techniques used in sex therapy in order to deal with the sexual issues they may encounter in their practice. This paper outlines a method of incorporating the psychotherapeutic techniques presently used in sex therapy into the marriage and family counselling setting when there is a sexual issue involved. The paper is separated into (1) a discussion of the problem, (2) recovering the relationship as the focus for sex therapy, and (3) the main approaches to treatment. Next, (4) practice issues are considered, with a presentation of couple therapy using concepts and techniques of sex therapy, including discussions on A. Identification of Organic Causes, B. Identification of Psychological Issues, C. Examination of Interpersonal Issues, and D. Assessment of Systemic Issues. (5) Some more common interventions are then presented.     

Dyadic Playfulness Differences Between Sexual and Marital Therapy Couples

Thirty-three clinical couples (17 sex therapy and 16 marital therapy) and fifty non-clinical couples were examined for potential differences in relationship playfulness utilizing the Couples Play Questionnaire. For clinical couples, Spanier's Dyadic Adjustment Scale, and Edmond's Marital Conventionalization Scale scores were also comparcd. Both sex therapy and marital therapy couples were found to be deficient in play compared to non-clinical couples, while marital therapy couples were found to be most deficient. Greater marital conventionalization scores were found for sex therapy couples suggesting that they favorably distort their self-assessmcnts. Results suggest that sex therapy couples may be the more inflexible of the three sample groups and may need therapeutic assistance with general relationship play as well as sexual play.     

Understanding heterosexual Chinese college students' intention to adopt safer sex behaviors

This study aimed to examine Chinese college students' safer sex behaviors and to explore whether or not the Theory of Reasoned Action would be useful in understanding AIDS/HIV‐prevention behaviors of Chinese students. A total of 455 Chinese college students (161 males and 267 females) in Hong Kong participated in the study. Results revealed that 24% of the students were sexually active during the surveyed year, with only 38.2% of them reporting regular condom use. About one third of the students intended to experiment with casual sex in the future, but only 64% would use condoms regularly if they were to have future casual sexual encounters. Results indicated that the Theory of Reasoned Action was most applicable in understanding Chinese college students’ intention to use condoms in future casual sexual encounters, rather than in current and future regular sexual activities. Specifically, students who intended‐to use condoms in future casual sex encounters tended to have accurate AIDS/HIV information, show little prejudice against people with AIDS/HIV, demonstrate greater concern about contracting AIDS/HIV, feel confident in condom use, and have positive attitudes toward safer sex behaviors. Gender disparity was also noted in the pattern of associations between safer sex behaviors and various psychological variables. Limitations of the present study and implications for future research were also discussed.     

HISTORICAL AND CURRENT FACTORS DISCRIMINATING SEXUALLY FUNCTIONAL FROM SEXUALLY DYSFUNCTIONAL MARRIED COUPLES*

Clinical literature has noted numerous past and current psychosocial factors characteristicof sexually dysfunctional individuals. However, there is almost no empirical documentation of factorsdiscriminating sexually functional from dysfunctional couples. The present study compared the responses of 94 clinical couples accepted for sex therapy with 110 nonclinical couples, selected from the same community. The couples were in their mid-30s, married an average of 12 years, middle income, rather well educated, and over 75% had at least one child. Individuals completed a 517-question Personal History Questionnaire (PHQ), and sex and marital defensiveness scales. The PHQ wasclinically and empirically developed, resulting in 54 internally consistent scales. Major analyses tested the discriminating power of past and current PHQ scales. The best discriminators were sexual functioning scales, historical and affective scales for women, and current and fantasy scales for men. Several surprising results appeared, including the importance of first coitus and the lack of importance of marital satisfaction, communication and sexual history scales. Four conclusionswere discussed relevant to the separation of sex and relationship satisfaction, the separation of sexualfunctioning and sexual satisfaction, and the differential impact of sexual problems on men and women.     

Expanding the boundaries of sex research

Sex researchers come from a vast array of disciplines, and sexual science is advanced through interdisciplinary communication and collaboration. Today, a greater number of academic disciplines are involved in this scientific network. In addition, our research has become more global in focus. This cross‐cultural study of sexuality has challenged some of our most basic assumptions and theoretical formulations. We have recognized that so many of our concepts, models, and theories are culturally bound (Herdt, 1989). The boundaries of topics of sex research are also expanding. We have moved beyond the scientific paradigm of reproductive biology and have begun to recognize that sexuality has many more purposes. Research on attraction, communication, types of relationships, gender, sex roles, sexual attitudes and values becomes a part of sexual science. In addition, our methodologies have been expanding beyond empirical research, and we have recognized the value of humanistic and phenomenological scientific methods. As we approach the next decade and the next century, we will find a new era of sex research—exploring and expanding the boundaries of sex research.     

Imbalanced sex ratios, men's sexual behavior, and risk of sexually transmitted infection in China

China has been experiencing pronounced changes in its sex ratio, but little research has explored the consequences of these changes for sexual behavior and health. We merge data from the 1999-2000 Chinese Health and Family Life Survey with community-level data from the 1982, 1990, and 2000 Chinese censuses to examine the relationship between the local sex ratio and several dimensions of men's sexual behavior and sexual health. Multilevel logistic regression models show that, when faced with a relative abundance of age-matched women in their community, Chinese men are slightly less likely to have intercourse with commercial sex workers, but are more likely to engage in premarital noncommercial intercourse and to test positive for a sexually transmitted infection. These findings are consistent with hypotheses derived from demographic-opportunity theory, which suggests that an abundance of opposite-sex partners will increase the risk of early, frequent, and multi-partner sex and, through this, sexually transmitted infection risk.     

Abstracts

Fritz, G. S., Stoll, K. and Wagner, N. N. A comparison of males and females who were sexually molested as children. Journal of Sex and Marital Therapy , 1981, 7 , 54–59.
Baisden, Major J., Jr. and Baisden, Joanna. A profile of women who seek counseling for sexual dysfunction. American Journal of Family Therapy , 1979, 7, 1 , 68–76.
Murphy, G. J., Hudson, W. W. and Cheung, P. Marital and sexual discord among older couples. Social Work Research Abstracts , 1980, 16, 11 , 11–16.
Chesney, A. P., Blakeney, P. E., Chan, F. A., and Cole, C. M. The impact of sex therapy on sexual behaviors and marital communication. Journal of Sex and Marital Therapy , 1981, 7 , 1, 70–79.
Price, S., Heinrich, A. G., and Golden, J. S. Structured group treatment of couples experiencing sexual dysfunctions. Journal of Sex and Marital Therapy , 1981, 6 , 4, 247–257.
Zilbergeld, B. and Rinkleib-Ellison, C. Social skills training as an adjunct sex therapy. Journal of Sex and Marital Therapy , 1979, 5, 4 , 340–350.     

Relationship Education and Therapy for Same‐Sex Couples

The gay and lesbian community suffers higher rates of discrimination, mental health problems, and relationship break‐up than their heterosexual counterparts. In this paper we analyse the challenges confronting same‐sex couples, and the implications for couple education and therapy with same‐sex couples. We describe some similarities in the challenges confronting heterosexual and same‐sex couples (e.g., negotiation of shared realistic relationship expectations, effective communication). These similarities suggest existing evidence‐based approaches to couple therapy and relationship education are likely to assist same sex couple relationships. We also describe distinctive challenges for same‐sex couples (e.g., homophobic discrimination, internalised homophobia, and low support from many families for same sex relationships). These distinctive challenges suggest some adaptation of existing approaches to couple education and therapy could enhance their relevance and effectiveness to same sex couples.     

Abstracts

Beal, E. W. Current trends in the training of family therapists.
Bryson, R. B., Bryson, J. B., Licht, M. H., & Licht, B. G. The professional pair.
Cromwell, R. E., Olson, D. H. L., & Founier, D. G. Tools and techniques for diagnosis and evaluation in marital and family therapy.
Hartley, D., Roback, H. B., & Abramowitz, S. I. Deterioration effects in encounter groups.
Jones, W. P. Some implications of the sixteen personality factor questionnaire for marital guidance.
Kelly, G. F. The counselor and human sexuality.
Mace, D., & Mace, V. The selection, training, and certification of facilitators for marriage enrichment programs.
Masters, W. H. & Johnson, V. E. Principles of the new sex therapy.
McConnell, L. G. An examination of the counselor's skills when counseling with sexual problems.
Meyer, J. K. Training and accreditation for the treatment of sexual disorders.
Robertielle, R. C. The decline and fall of sex.
Rubin, Z., & Mitchell, C. Couples research as couples counseling.
Sager, C. J. The role of sex therapy in marital therapy.
Whittaker, J. K. Causes of childhood disorders: New findings.     

Economic evaluation of brief sex counseling for sexually dysfunctional adolescents

Objectives: In a randomized controlled trial brief sex counselling (BSC), intensive sexual healthcare (ISH) and no treatment (NT) for adolescents with a sexual dysfunction were compared. The aim of this study was to assess the cost-effectiveness and cost-utility of BSC versus ISH and NT from a societal perspective. Methods: Costs, sexual functioning and quality of life were measured during 6 months. Primary outcome measures were measured with the Female Sexual Functional Index, the International Index of Erectile Function and the utilities reflecting Quality of Life based on the SF-36. Uncertainty was dealt with by using bootstrap replications and sensitivity analyses. Results: Results show that the societal costs were the highest for ISH followed by NT and BSC. The difference in costs between ISH compared to NT and BSC was significant. Furthermore, there were no significant group differences in sexual functioning or quality of life. With respect to the cost-effectiveness and cost-utility, BSC can be considered to be a suitable treatment for adolescents with a sexual dysfunction. Conclusions: Due to the lack of a significant difference in clinical effect, it can be concluded that BSC is the cheapest treatment option when implementing the intention-to-treat, besides a no treatment option, for adolescents with a sexual dysfunction.     

Gender-biased behavior at work: Exploring the relationship between sexual harassment and sex discrimination

This paper examines survey-based reports of sexual harassment and sex discrimination in order to identify the stylized facts about the nature of the relationship between them. In particular, we are interested in assessing whether these concepts measure similar forms of gender-biased behavior and whether they have the same effect on workers’ job satisfaction and intentions to leave their jobs. Our results provide little support for the notion that survey-based measures of sexual harassment and sex discrimination capture the same underlying behavior. Respondents do appear to differentiate between incidents of sexual harassment and incidents of sex discrimination in the workplace. There are gender differences in the consequences, however. Both sex discrimination and sexual harassment are associated with a higher degree of job dissatisfaction. However, women’s intended job changes appear to be more sensitive to experiencing sex discrimination, while men’s are more sensitive to experiencing sexual harassment. Although exploratory, when taken together these results give us hope that in the future sufficiently detailed surveys could provide a useful foundation for quantifying the link between sexual harassment and sex discrimination. They also suggest that the best prospect for developing—and then testing—a conceptual framework of gender bias lies in adopting a multi-disciplinary approach incorporating the insights of disciplines such as sociology, psychology, and economics.     

MORNING AND NIGHT COUPLES: THE EFFECT OF WAKE AND SLEEP PATTERNS ON MARITAL ADJUSTMENT*

This study explored the effects of spouses' wake and sleep patterns on marital adjustment. A total of 150 couples from three states completed questions on wake/sleep patterns, marital interaction, marital adjustment, and problem solving. Couples whose wake and sleep patterns were mismatched (e.g., an evening person married to a morning person) reported significantly less marital adjustment, more marital conflict, less time spent in serious conversation, less time spent in shared activities and less frequent sexual intercourse than matched couples. Contrary to expectations for matched couples, night couples did not report more involvement in extra-familial social activities than morning couples. Morning couples engaged in sexual intercourse more frequently in the morning than night couples; night couples had sex more often in the evening than morning couples. There were no significant differences in the intercourse rates for morning couples and night couples. Compared to matched couples, mismatched couples with high marital adjustment reported more flexibility and adaptability in their marital problem solving. The implications of these findings for premarital counseling and marital therapy are discussed.     

Assessing the geographic distribution of same sex and opposite sex couples across the United States: implications for claims of causality between traditional marriage and same sex unions

The percent of households headed by married couples has recently fallen below 50%, while the percent of unmarried couples (both heterosexual and homosexual) continues to rise. Nationally-representative estimates of unmarried couples which first appeared in the 1990 and 2000 decennial Censuses are now available on an annual basis through the American Community Survey. In this paper we use state-level panel data from 2000–2006 on the percent of households headed by married couples, same sex couples and opposite sex unmarried couples to assess widespread claims in the popular press of causality across living arrangements. Based on Granger causality tests we can reject claims that an increase in same sex couples has caused either a decline in marriage or (except in one case) an increase in heterosexual cohabitation. There is mixed evidence whether or not opposite sex couples may have Granger caused same sex couples, but stronger evidence that marriage and heterosexual cohabitation are interrelated.