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With a new preface by the author, this updated edition explores the ways in which passion can be kept alive and how the height of sexual and emotional fulfillment can be reached in later life.

Summary Weight gain and body fat increase the risk of cardiometabolic disease. Cross‐sex hormone therapy in transgender persons leads to changes in body weight and body composition, but it is unclear to what extent. We performed a meta‐analysis to investigate the changes in body weight, body fat and lean body mass during cross‐sex hormone therapy in transgender persons. We searched the PubMed database for eligible studies until November 2015. Ten studies reporting changes in body weight, body fat or lean mass in hormone naive transgender persons were included, examining 171 male‐to‐female and 354 female‐to‐male transgender people. Pooled effect estimates in the male‐to‐female group were +1.8 kg (95% CI: 0.2;3.4) for body weight, +3.0 kg (2.0;3.9) for body fat and −2.4 kg (−2.8; −2.1) for lean body mass. In the female‐to‐male group, body weight changed with +1.7 kg (0.7;2.7), body fat with −2.6 kg (−3.9; −1.4) and lean body mass with +3.9 kg (3.2;4.5). Cross‐sex hormone therapy increases body weight in both sexes. In the male‐to‐female group, a gain in body fat and a decline in lean body mass are observed, while the opposite effects are seen in the female‐to‐male group. Possibly, these changes increase the risk of cardiometabolic disease in the male‐to‐female group.

Purpose of the Review This review will examine the current, although limited, literature on the development of healthy sexuality for sex offenders, as well as some of the related controversies surrounding sex offender specific therapies. Recent Findings Over the last decade, the definition of healthy sexuality has remained elusive while the boundary delineating unhealthy sexuality has radically changed. These changes are not reflected in current approaches to sex offender treatment which continue to focus on suppression of offenders’ sexuality. Summary Our attention to the management of sexual behaviors has led to a diminished, and perhaps impoverished, curiosity and understanding of what is driving problematic sexual behavior and also moves us further from an understanding of what leads to “healthy” sexual behavior. It is our contention that a consideration of sex offending behavior through the lens of early childhood trauma will lead to an improvement in our ability to assist these offenders in the development of sexually happier and more fulfilling lives while being able to function within the parameters of society’s standards for legal behavior. The sex positive perspective of sex therapy will allow for a broader consideration of what defines and promotes healthy sexual behavior in an offender population.

Psychotherapists often believe if couples improve their communication and emotional dynamics, good sex follows. In practice we often find otherwise and have many questions about how to proceed to work with sexuality issues more directly. This paper presents the many challenges working with sex including the following: the fluidity and multidimensionality of sex and gender, the incongruities and paradoxes in sexual behavior, thoughts, attractions, feelings, and sensations, and the powerful feelings, impasses, surprises, and confusion therapists often experience doing the work. In essence, what is queer about sex? Using the couple as client, expansive ways of thinking and working with sexuality are presented including the development of inclusive models of sex, gender, and sexual response, as well as new approaches to standard sex therapy techniques such as sexual history‐taking, redefining sex, and sensate focus. Techniques are presented with an emphasis on the therapist's use of self as sexual change agent including integrating multiple theoretical perspectives (psychodynamic, systemic, and cognitive‐behavioral), co‐creating a safe treatment frame, and how to intervene within the cognitive, affective, behavioral, somatic, and discursive realms. RESUMEN Con frecuencia, los psicoterapeutas creen que si las parejas mejoran su comunicación y dinámica emocional tendrán mejor sexo. En la práctica, a menudo descubrimos lo contrario, y tenemos muchas preguntas acerca de cómo empezar a trabajar con los problemas de sexualidad de una manera más directa. En este artículo se presentan los diversos desafíos que implica trabajar con el sexo, por ejemplo: la fluidez y la multidimensionalidad del sexo y el género, las incongruencias y paradojas del comportamiento sexual, los pensamientos, las atracciones, los sentimientos y las sensaciones, y los sentimientos fuertes, los estancamientos, las sorpresas y la confusión que a menudo sienten los terapeutas al trabajar. Esencialmente, ¿qué es lo raro (queer) del sexo? Utilizando a la pareja como paciente, se presentan maneras amplias de pensar y trabajar con la sexualidad, entre ellas, el desarrollo de modelos inclusivos de sexo, género y respuesta sexual. También se ofrecen enfoques nuevos con respecto a las técnicas de terapia sexual estándar, como la elaboración de la historia sexual, la redefinición del sexo y la focalización sensorial. Las técnicas se presentan con un énfasis en el uso del yo del terapeuta como agente de cambio sexual. Estas abarcan la integración de múltiples perspectivas teóricas (psicodinámicas, sistémicas y cognitivo‐conductuales), la co‐creación de un marco de tratamiento seguro, y cómo intervenir dentro de los ámbitos cognitivos, afectivos, conductuales, somáticos y discursivos. Palabras clave: queer, sexualidad, terapia de pareja, psicoterapia, género

First published in 1997. Routledge is an imprint of Taylor & Francis, an informa company.

Sexual dysfunctions (SD; e.g., female sexual interest/arousal disorder, erectile disorder, female orgasmic disorder, delayed ejaculation, genito-pelvic pain/penetration disorder, etc.) affect up to a third of individuals, impairing sexuality, intimate relationships, and mental health. This study aimed to compare the prevalence of SDs and their sexual, relational, and psychological correlates between a sample of adults consulting in sex therapy ( n = 963) and a community-based sample ( n = 1,891), as well as examine barriers to sexual health services for SD and the characteristics of individuals seeking such services. Participants completed an online survey. Analyses showed that participants in the clinical sample reported lower levels of sexual functioning and sexual satisfaction and higher levels of psychological distress than participants in the community-based sample. Moreover, higher SD rates were related to lower relational satisfaction and higher psychological distress in the community sample, and to lower sexual satisfaction in both samples. Among participants in the community sample who sought professional services for SD, 39.6% reported that they were unable to access services, and 58.7% reported at least one barrier to receiving help. This study provides important data regarding the prevalence of SD and the link between SD and psychosexual health in clinical and nonclinical samples, as well as barriers to treatment access.

There is emerging evidence for the efficacy of mindfulness-based interventions for improving women’s sexual functioning. To date, this literature has been limited to self-reports of sexual response and distress. Sexual arousal concordance—the degree of agreement between self-reported sexual arousal and psychophysiological sexual response—has been of interest due to the speculation that it may be a key component to healthy sexual functioning in women. We examined the effects of mindfulness-based sex therapy on sexual arousal concordance in a sample of women with sexual desire/arousal difficulties ( n  = 79, M age 40.8 years) who participated in an in-laboratory assessment of sexual arousal using a vaginal photoplethysmograph before and after four sessions of group mindfulness-based sex therapy. Genital-subjective sexual arousal concordance significantly increased from pre-treatment levels, with changes in subjective sexual arousal predicting contemporaneous genital sexual arousal (but not the reverse). These findings have implications for our understanding of the mechanisms by which mindfulness-based sex therapy improves sexual functioning in women, and suggest that such treatment may lead to an integration of physical and subjective arousal processes. Moreover, our findings suggest that future research might consider the adoption of sexual arousal concordance as a relevant endpoint in treatment outcome research of women with sexual desire/arousal concerns.