Sexual Dysfunction

One of the most impressive aspects of Masters and Johnson's (1970) therapeutic approach with almost 800 people with sexual problems was that they reported success in treating more than 80 percent of their clients who experienced various types of sexual dysfunction. Of the successful clients who could be found five years later (313 couples), only 5 percent reported recurrence of the dysfunctions for which they had obtained treatment. The therapeutic community was quite impressed with the success of Masters and Johnson's approach, and for years other therapists used modified versions of many of their methods.

Gradually, however, outcome statistics reported from clinical practice revealed overall improvement in only about two-thirds of cases. The improvements obtained from controlled treatment studies have all been more modest than the proportions Masters and Johnson reported. Do these finding indicate that the only reliable source of sex therapy is Masters and Johnson? Probably not. Instead, differences between the failure rates that Masters and Johnson reported and those that other sex therapists and researchers reported probably stem from a combination of factors other than Masters and Johnson's skills as therapists.

In addition, many of the problems that Masters and Johnson's clients experienced stemmed from misinformation and ignorance. People in the 1950s and 1960s did not have the easy access to information about sexuality that exists today. Clients today whose problems stem from a lack of information may be "curing" themselves instead of seeking professional treatment. The caseloads of sex therapists today may include a greater proportion of clients with sexual difficulties resulting from deeply rooted emotional problems or from conflicts within their relationships—sexual problems that are often difficult to treat. This factor would, of course, result in lower success rates and higher relapse rates.

Another question that must be addressed in the evaluation of any sex therapy is whether the treatment yields sustained change over the years. There is very little available research on this subject. Summarizing what is known, Keith Hawton (1992) reported that the successful short-term results of sex therapy for erectile dysfunction was maintained in the long-term (one to six years), whereas those for premature ejaculation were less permanent. Men with low sexual desire had a fairly poor response to treatment in the short- and long-terms. Sex therapy for vaginismus was highly effective in the short- and long-terms, whereas the long-term results of treatment for low sexual desire in women were fairly poor. Interestingly, there was improvement in the way a number of clients felt about their sexuality, despite the fact that some had returned to pretreatment dysfunctions in sexual behavior. If these clients had received occasion clinical "booster" sessions over the years, their post-treatment improvement would perhaps have been maintained through preventive measures.