Professional Documents
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ORIGINAL RESEARCH
Meta Associates, St. Paul, MN, USA, 2American University, Washington, DC, USA
ABSTRACT The Good-Enough Sex model presents a commonsense yet comprehensive perspective
that challenges simplistic notions of sex and encourages couples to pursue positive, realistic meaning in
their intimate lives. With the Good-Enough Sex model, intimacy is the ultimate focus, with pleasure as
important as function, and mutual emotional acceptance as the environment. Sex is integrated into the
couples daily life and daily life is integrated into their sex life to create the couples unique sexual style.
Living daily life well with its responsibilities, stresses, and conflicts provides the opportunity to
experience sexual interactions in a subtly yet distinctively personalized and enriched way. Sex at times
is experienced as pleasure, stress relief, mature playfulness, and on another occasion as a spiritual
union. Intimate couples can value multiple purposes for sex and use several styles of arousal. GoodEnough Sex is congruent with the couples genuine lifestyle. Good-Enough Sex recognizes that among
satisfied couples the quality of sex varies from day to day and from very good to mediocre or even
dysfunctional. Such reasonable expectations are an important feature of sexual satisfaction as well as
inoculating the couple from disappointment and sexual problems in the future. The Good-Enough Sex
perspective serves as the foundation for relationship and sexual satisfaction.
KEYWORDS: Good-Enough Sex model; sexual satisfaction; sexual dysfunction; biopsychosocial model;
couple sexuality; sexual health
Introduction
Approximately 45 percent of couples at a given time suffer a male, female or couple
sex problem (Laumann et al., 1999). While awareness of sexual dysfunction (SD) has
increased in recent years with the advances in sexual medicine, clinical experience
demonstrates that SD is rarely a simple performance problem with a simple cure. A
sexual issue is commonly a profound human, relationship problem, which involves
emotional suffering, distress, even agony. Because of this potentially profound
psychological distress, SD is internationally classified as a psychiatric disorder
according to the American Psychiatric Association, Diagnostic and Statistical Manual
Correspondence to: Michael E. Metz, Baker Court Office Bldg, Suite 440, 821 Raymond Avenue,
St. Paul, MN 55114, USA. Tel. 1 651 642 9317x107. Fax: 1 651 642 1908.
E-mail: mmetzmpls@aol.com
Received 7 March 2006; Accepted 15 September 2006.
ISSN 1468-1994 print/ISSN 1468-1749 online
British Association for Sexual and Relationship Therapy
DOI: 10.1080/14681990601013492
352
IV (DSM-IV-TR, 2000) and the International Classification of Disorders-10 (ICD10; World Health Organization, 1992).
SD offers an exceptional opportunity for the helping professional to offer support
and to enhance the quality of life of the individual and couple. Few medical or
psychological problems so clearly offer the clinician not only the opportunity to
relieve distress but also to promote personal and relationship health and satisfaction.
To do this, the following concepts are essential:
1.
2.
3.
4.
5.
6.
Real-life problems rarely have a simple cause and a simple cure in spite of
peoples longing for quick fixes. SD is complicated. It is multi-causal,
multidimensional and has multiple effects on the person, the partner and their
relationship.
Satisfaction with ones sexual life is fundamentally grounded on realistic
physical, psychological and relationship expectations. Unrealistic expectations
precipitate frustration, a sense of failure, and distress.
The emphasis on perfect sexual performance is self-defeating and needs to be
replaced by the Good-Enough Sex model, which realistically recognizes the
inherent variability of couple sex.
Any approach to SD must recognize that regardless of the cause(s), sex is a
relationship problem affecting the emotional life of the couple.
Treatment for SD needs to be individualized to this couple, not one size fits
all.
Effective treatment must integrate medical, pharmacological, psychological, and
relationship aspects with an individualized relapse prevention plan.
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1
2
3
4
5
6
7
8
9
10
11
12
Sex is a good element in life, an invaluable part of an individuals and couples long-term comfort,
intimacy, pleasure, and confidence
Relationship and sexual satisfaction are the ultimate developmental focus and are essentially
intertwined. The couple is an intimate team
Realistic, age-appropriate sexual expectations are essential for sexual satisfaction
Good physical health and healthy behavioral habits are vital for sexual health. Individuals value
their and their partners sexual body
Relaxation is the foundation for pleasure and function
Pleasure is as important as function
Valuing variable, flexible sexual experiences (the 85 percent approach) and abandoning the
need for perfect performance inoculates the couple against sexual dysfunction by overcoming
performance pressure, fears of failure, and rejection
The five purposes for sex are integrated into the couples sexual relationship
Integrate and flexibly use the three sexual arousal styles
Gender differences are respectfully valued and similarities mutually accepted
Sex is integrated into real life and real life is integrated into sex. Sexuality is developing, growing
and evolving throughout life
Sexuality is personalized: Sex can be playful, spiritual, special
356
4. Good physical health and healthy behavioral habits are vital for sexual health.
Individuals value their and their partners sexual body
Sexual function is important (although not essential) for sexual satisfaction. Care for
their own physical health and healthy behaviors (e.g. adequate sleep, exercise, eating,
and moderate drinking) are an important dimension of continuing sexual functioning, especially with aging. Because illness is a significant enemy of sexual function and
increases in prevalence with aging, wellness is an important goal. With recent medical
advances, in many cases sexual function may be facilitated with medications and
devices, but these need to be integrated into the couples sexual style, not be stand
alone interventions (McCarthy & Fucito, 2005).
5. Relaxation is the foundation for pleasure and function
Physiological, psychological, and interpersonal relaxation is the basis for sexual
function as well as personal and relationship satisfaction and becomes increasingly
important after age 30. The vitality of youth can overcome high levels of anxiety,
tension, and performance anxiety that otherwise inhibits physical functioning. The
foundational work of Masters and Johnson (1970) and the behavioral exercises they
developed (sensate focus) were grounded on bio-physiologic relaxation as the
cornerstone of adequate sexual function. Although sometimes misinterpreted as a
rigid performance criterion, Masters and Johnson advocated that by removing the
barriers to healthy sexual function (for example, performance anxiety, shame,
cognitive distraction, negative relationship conflict that is, by promoting physical,
emotional, and interpersonal relaxation), the body and mind would naturally
respond and adequately function sexually (e.g. arousal, orgasm) (e.g. Basson, 2001).
More recently, it is also instructive to appreciate that the physiological mechanism of
the PDE5 pro-erection medications is to relax the musculature surrounding the
arteries in the penis to enable blood flow and erection. While counterintuitive,
physiologic relaxation is the vital mechanism of erection. The abundant evidence of
the role of anxiety in sexual dysfunction (see Barlow, 1988) is counterpoint to the need
for physiologic and psychologic relaxation to ameliorate performance pressure and
anxiety, enhance pleasure and share enjoyable couple sex. Men may worry that a
lessening of erotic stimulation if he focuses on physiologic relaxation during sexual
touch may itself cause an erection problem. In fact, physical relaxation and the focus
on the pleasure of touch instead facilitates easy and more reliable erections (Metz &
McCarthy, 2004) as the mechanism of the PDE5 pharmacologic agents demonstrate.
It is counter-productive, for example, for a man to pressure himself to achieve perfect
sexual performance. In fact, it is important to not work too hard sexually, because to
facilitate function one does well to relax both mind and body amidst the sexual
pleasuring. Striving for perfection undermines physiologic and psychological
relaxation, producing performance pressure and anxiety.
Awareness of the value of relaxation also accentuates the importance of
psychosexual skills. Couple sex therapy has refined the cognitive, emotional, and
behavioral skills such as taking personal responsibility for pursuing sexual growth;
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360
with aging, enjoying increased time flexibility after retirement. Good-Enough Sex is
congruent with the couples relationship style and makes it special.
12. Sexuality is personalized: Sex can be playful, spiritual, special
The Good-Enough Sex model challenges couples to consider not only lovemaking
behaviors and psychosexual skills but emotional experiences and meaning in their
intimate relationship. This model advocates that emotional intimacy and relationship
satisfaction is the ultimate focus. The experience of satisfying sex is at times playful,
spiritual, special. A reliable indicator of Good-Enough Sex is the occasional presence
of playfulness (Margolin, 1983; Metz, 1988). Certain features of traditional sex
therapy were designed to reestablish couple playfulness (Tullman et al., 1981) as
couples experiencing SD have been found to be sexually rigid and deficient in
private playfulness. For example, Metz and Lutz (1990) compared sex dysfunction,
marital dysfunction, and satisfied couples and found the SD couples notably deficient
in playfulness even compared to maritally distressed couples. Playfulness may be such
a good indicator of Good-Enough Sex because for play to occur, other aspects of
intimacy must be functioning well: trust, mutual acceptance, priority on pleasure,
freedom to be oneself, and deep valuing of the relationship. The idiosyncratic nature
of couple playfulness during sexual interaction (such as affirming teasing or
nicknames for sexual body parts) adds uniqueness to the couples sexual
experiences and personalizes the bedroom (makes it special).
Couple reports of sexual playful behaviors include: special apparel (negligee, leopardskin briefs); role play/enactments (e.g. acting out sex fantasy (pirate/maiden; movie
scenarios); sexual toys vibrator, dildo, fur mitt, body oil; sharing fantasies and sexual
dreams; erotic movies (R- or X-rated); special places (beautiful bed and breakfast, beach,
woods, car); special teasing (romantic seduction, playful withholding); special times
scheduling sexual times such as afternoon delight; public and private dancing with/for
the partner; nicknames for sexual body parts (e.g. Grand Tetons, Big Ben).
The idiosyncratic meaning of sexual playfulness is illustrated in two couple
descriptions of their sexual playfulness. The first is a 34-year-old male lawyer who wrote:
We spend time tickling each other which is sometimes sexual and sometimes
not. We will touch each other sexually while doing normal everyday things. We
will accidentally touch each other. We chase each other in the house. I will
sneak up on her while she is changing. I will expose myself at times in the house
when we are alone. My wife will give me a sneak peek when she teases. We take
showers together and will sometimes wash each other with sexual overtones.
A 32-year-old female teacher explained:
I love to dress up for my husband in lacy clothes one time, then my regular
underwear another. I also sometimes beg him in a playful way (I get down on
my knees and BEG dramatically!) to dress for me in his tuxedo or leopard skin
briefs . . . that I have to have him this way . . . Its a spoof and a tease! But it
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Contributors
MICHAEL E. METZ, PhD, Psychologist and Marital & Sex Therapist in Private Practice,
Meta Associates, St. Paul, MN USA.
BARRY W. MCCARTHY, PhD, Professor of Psychology, American University,
Washington, DC, and certified sex and marital therapist.