Throughout history, people have sought aphrodisiacs to increase their sexual desire and enhance their sexual performance. Instead of turning to folk remedies such as rhinoceros horn or Spanish fly, men and women today, particularly those approaching middle age, are looking to their physicians for answers.
In recent years, patients have been entering therapy complaining of a reduction of their erotic spirit.' This phenomenon is due to the explosion of very explicit sexually charged messages in just about every aspect of society, simultaneously desensitizing and stimulating the viewer. At the same time, a conservative movement is mounting against sex education and the availability of sex-related businesses. This, of course, leaves our patients even more bewildered about an area of life that is already fraught with confusion.
From television and movies, magazine articles, and music, to the private parts and private lives of our public figures, there are few sexual secrets left for us- and very little mystery. Confused and guilty, our patients are groping for subtler, more personal forms of erotica to reawaken their besieged erotic lives. They also seek guidance in dealing with guilt, confusion, and performance expectations in their sex lives, and so turn to us, as therapists, for direction and approval.
Sex therapists have long appreciated the usefulness of erotic materials in helping patients achieve their desire for sexual fulfillment. Previously confined to a subculture, erotica has become more widely accepted and is increasingly enjoyed by women and couples in the mainstream (P. Britton, PhD, personal communication, October 1998).
Helen Singer Kaplan, MD, PhD, the late psychiatrist and world-renowned sex therapist, often recommended erotic videos to her patients, describing them as "non-chemical aphrodisiacs" (H. Singer Kaplan, MD, PhD, personal communication, March 1994). This suggestion is particularly appropriate for individuals with hypoactive sexual desire, and problems of arousal and orgasm, excluding premature ejaculation. Prescribing erotic videos can also be helpful in differentiating psychogenic from physical causality.2
Traditionally, erotic videos were made to appeal exclusively to men. Many women found this old style "porn" offensive and insensitive, indicating a need in this market for a product that addressed women's sensibilities. From this quest emerged a new sensitive genre of film created by and targeted for females. Such women as Candida Royalle (Femme Productions), Debra Shane ("Cabin Fever"), and Jane Hamilton (also called Veronica Hart) have made excellent contributions to this field.3,4
Sex education videos that both educate and excite the viewers are becoming more popular. This type of video is based on the premise that people learn best when they are sexually aroused. Good examples are Betty Dodson's "Viva la Vulva," Nina Hartley's series of Sex Education Guides, and the Sinclair Institute Better Sex Series.
Playful, sensual, and titillating, sex toys can be a great enhancement to your patient's sex life. Female patients report that one of the greatest inventions of all time is the vibrator. There are many types and shapes of vibrators. Some strap on or are handheld for clitoral stimulation. Others are phallus-shaped and designed for vaginal or rectal insertion. Still others arouse the clitoral and vaginal areas at the same time. The egg-type vibrator is another model that may be used by both men and women. These are approximately the shape and size of a vibrating lipstick and are connected by a thin cord to a power source. They may be covered with a condom and inserted in either the rectum or the vagina. When placed in the rectum, they do not interfere with intercourse, nor do they need to be held in place. Men with erectile disorder and retarded ejaculation benefit from vibrating rectal stimulation. Women benefit as well from additional vaginal, cervical, or "G" spot stimulation. Products made of silicone are the most hygienic, pliable, and soft to the touch. Special cleansers for adult toys are available that are nonreactive and contain nonoxynol 9.
Body lotions and personal lubricants help excite and propel one into sexual bliss by adding moisture and/or a sensual fragrance. Synthetic human pheromones that mimic the body's own natural sexual attractanfcs and inspire an erotic response in the opposite gender are now available for purchase.5 Sex toys also include items that foster more kinky eroticism, such as sadomasochistic (S/M) or bondage and dominance (B/D) sexual acts. The books The Guide To Getting It On6 and The New Good Vibrations Guide to Sex7 are two helpful guides to using a wide variety of sex toys. Nina Hartley has also produced a video entitled "Guide to Sex Toys" that is informative.
THERAPEUTIC USES OF EROTICA
For patients who want to add diversity to a monogamous relationship, erotic products expand the sexual repertoire. For instance, for those who crave partner variety without risk, Cameron Grant's "The Dinner Party" shows a variety of couples engaged in a fantasy group sexual experience. This not only provides exposure to group sex, but also offers visual examples of many lovemaking techniques.
For patients whose low libido is due to difficulty with focusing on sexual fantasy, an immediate visual stimulus can trigger sexual desire. Watching a variety of erotic videos also enables patients to sample different types of visual stimulation and then determine the type that is optimal for them.
For patients with partner-specific hypoactive desire, a video can inspire arousal by helping patients focus on a more appealing image than their partner. In global desire disorders, specifically when there is little or no physiologic causality, the most helpful videos are the more explicit ones showing graphic sexual acts and sexual body parts. These patients need a jolt, an overload of stimuli, to allow them to feel more intensely sexual and to bypass their resistance to desire and performance. The key, of course, is the patient's ability to focus on sensory-based feelings and/or erotic thoughts and fantasies. Sex aids can be tremendously helpful as well because they enhance sensations and trigger erotic fantasy.
For patients with arousal problems due to performance anxiety, erotic videos and vibrators can help them "take a detour" around their anxious feelings. In other words, the powerful image or sensation provided by the sex aid can distract the patient from his or her preoccupation with sexual functioning or anti-erotic thoughts, allowing feelings of arousal to flourish. Further, a person with a medication-induced sexual problem can benefit from pumping up the volume of stimuli through erotic video.
Erotica can help couples with incompatible sexual fantasies to function together. For instance, it can be used to introduce a partner to a new mode of sexual experience that he or she might otherwise find distasteful or unacceptable. For example, one male patient preferred to be dominated during sex, but his wife was not comfortable playing this part. After viewing a video portraying this, she felt more assured and was able to take the dominant role. Some of the accessories available in sex stores and catalogs that complement this fantasy role-play are whips, restraints, and blindfolds.
Communication between lovers about sexual feelings and needs is poorly portrayed in the media at large. Even mainstream movies depict sex without conversation, or dialogue that is insensitive or ambiguous. The newer erotic videos provide good role models by demonstrating couples offering suggestions, comments, and appreciation to one another, often referred to as "pillow talk." They also give the viewer permission to model the behavior. These female actors in the new genre of erotic videos initiate sex and present a convincing and instructive picture of how women pleasure themselves and their partners. For women who have never had an orgasm, or for those who are inhibited in the presence of a partner, the videos demonstrate a variety of ways to achieve orgasm, including clitoral assistance during intercourse. For women who are too inhibited or embarrassed to ask, erotica can provide a much-needed bridge.
Erotic videos and vibrating toys are particularly valuable to older patients who require more heightened stimulation. They also can help dispel the belief that aging means the loss of one's femininity or masculinity and one's interest in sexual matters.8 Videos that feature older couples are quite powerful at debunking the notion of asexuality in older years. Some examples are "Three Daughters," "Sex- A Lifelong Pleasure," "Love and Aging," and "Sex after Fifty." They also can be valuable to seniors who have lost a lifelong spouse and may be unfamiliar with sexual acts like masturbation or oral sex.
For patients with chronic pain, the newer videos diminish the focus on genital sex while encouraging foreplay and sensuality. For example, women with chronic interstitial cystitis often experience discomfort during or after prolonged intercourse. Videos, as well as lotions and lubricants, may help them to become more aroused prior to or instead of penetration.
Incorporating the patient's values, preferences, sexual issues, and state of readiness into the selection of erotica is paramount. Therefore, before making the recommendation, the therapist needs to become familiar with the myriad of erotic products currently available. Ideally, therapists should view the videos themselves before recommending them to ascertain their appropriateness.
Oftentimes, patients may feel embarrassed about renting a video or buying a sex-related item. Or, they might engage in critiquing the video or product, rather than connecting to it in an erotic fashion. These responses are often based on fear, shame, not wanting to look foolish, or being afraid of ridicule and/or rejection from their partner. Of course, this all presents good therapeutic opportunities to address sexual issues, work through resistances, and resolve psychosexual problems. The teachable moment comes when we can allay fears and enhance the full expression of sexuality and pleasure.
CONDITIONS FOR WHICH EROTICA IS NOT RECOMMENDED
For men with premature ejaculation, heightening fantasy or arousal is not recommended, as it distracts them from focusing on penile sensations, which is required to control ejaculatory timing. Certain erotic videos are also not suggested for patients with sexual aversion disorders, as these patients can become overly anxious when viewing videos that contain material too advanced for them. Also, some women with a history of sexual abuse may respond negatively to erotica that degrades or objectifies females.
Some men with erectile disorder or insecurity about penis size can become discouraged when viewing well-endowed men who function with relative ease. Traditional adult movies can heighten performance anxiety because many portray male actors with constant erections. However, the new style of erotic video depicts men in a more realistic manner.
Similarly, women with poor body image might feel threatened viewing videos featuring beautifully proportioned female bodies. Amateur erotic videos may be a good alternative for some because they portray real people of all shapes and sizes, rather than professional actors with "perfect bodies."
As therapists, it is imperative that we encourage patients to view sexuality in a positive fight, and give them permission to explore and enrich their sexual relationships. Erotic products can be extremely helpful to this process because of their potential to arouse passion through pictures, sounds, and sensations, while allowing patients to achieve greater sexual satisfaction and intimacy. These products can be readily found in video stores, mail-order catalogs, and sex-store web sites.
1. Bartlik B, Striar S. The use of erotic video in sex therapy. Cliniscope: The American Academy of Clinical Sexologists Clinical Monograph. 1998;7.
2. Kaplan HS. TAc Evaluation of Sexual Disorders: Psychological and Medical Aspects. New York: Brunner/Mazel; 1983.
3. Cohen A, Fox S. The Wise Woman's Guide to Erotic Videos. New York: Broadway Books; 1997.
4. Brent S, Brent E. The Couple's Guide to the Best Erotic Videos. New York: St. Martin's Griffen; 1997.
5. Cutler WB. Human sex-attractant pheromones: discovery, research, development, and applications in sex therapy. Psychiatric Annate. 1999;29:54-59.
6. Joannides P. The Guide To Getting It On. West Hollywood, CA: The Goofy Foot Press; 1999.
7. Winks C, Semans A. The New Good Vibrations Guide to Sex. San Francisco: Cleis; 1997.
8. Striar S, Hoffman K. Advocating for the socio-sexual rights of the single elderly: a sex-step intervention strategy. Journal of Social Work & Human Sexuality. 1984;3:1.
Adam & Eve, PO Box 800, Carrboro, NC 27510. 800-765-2326, Available Internet: <www.adameve.com/>.
Athena Institute (manufacturer of pheromones), 1211 Braefield Road, Chester Springs, PA 19425. 610-8242200. Available Internet: <www.athena-inst.com/>.
Eve's Garden, 119 W. 57th St., #1201, New York, NY 10019. 800-848-3847. Available Internet: <www.evesgarden. com/>.
Femme Productions, PO Box 268, New York, NY 10012. 800456-LOVE. Available Internet: <www,royaUe,com/>.
Good Vibrations, San Francisco, CA. 800-289-8423. Available Internet: <www.goodvibration.com/>.
Kaplan HS. The Sexual Desire Disorders: Dysfunctional Regulation of Sexual Motivation. New York: Brunner/Mazel; 1995.
Morin J. 77ie Erotic Mind. New York: Harper Perennial; 1995.
Sinclair Intimacy Institute, PO Box 8865, Chapel Hill, NC 27515. 800-888-1900. Available Internet: <www. bettersex.com/>.
Steinberg D. The Erotic Impulse. New York: Penguin Putnam; 1992.
Westheimer R. Sec for Dummies. Foster City, CA: IDG Books Worldwide; 1995.