Gay Lesbian and Bisexual Adults

These three groups present with the same varieties of sexual dysfunction discussed above, and the treatment plans, whether physical or psychological, are about the same. However, there are some additional factors that need to be taken into account. The first of these is the fact that, even though a gay or lesbian individual is seeking help, this does not necessarily mean that they are publicly "out" and that everyone knows of their sexual orientation. A second factor is the common use of high-tech sex toys, pornography, and in men, "fist-fucking," sadomasochistic practices, and water sports (urination). Lesbians, on the other hand, may well have feminist views and may have political views on sexual intercourse that may appear to be at odds with those of the therapist. Furthermore, views on pornography, sexual exploitation, and the existence of a patriarchal society may well contribute to models of behavior and expectations of treatment at variance with those of heterosexual women.

Some additional issues in working with these three groups include problems of society's widely held homophobic views and practices, the individual's internalized homophobia, and difficulties inherent in same-sex relationships. On the other hand, same-sex couples have the advantage of not being bound by opposite sexual role expectations, for example, the male must always initiate, and the female must be submissive. Gay men and lesbians tend to have a more varied sexual repertoire, and penetration is not the main focus of the sexual activity. The relationships may be open and nonmonogamous. The therapist's views on nonmonogamy and knowledge of the gay subculture may prove to be of great relevance for the success of therapy. The therapist must inquire closely about the development of sexual identity, detecting discrepancies in sexual orientation in the two partners, identifying the problem areas in the relationship and then setting up appropriate intervention procedures.

Bisexual individuals may feel unable to bring either

Sexual Dysfunction Therapy partner, and their problems may be with one gender or the other. The nonheterosexual orientation must be seen as equal but different, and the clinician must be familiar with group subcultures. Sexuality carries different meanings for gay men and lesbians and bisexual individuals, and these need to be ascertained and the emphasis on nonpenetrative pleasure encouraged.

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