The Masters and Johnson Approach to Sex Therapy

Sexual dysfunctions are characterized by alterations in one or more phases of the sexual response cycle. The Masters and Johnson sexual therapy model, developed in the 1970s, provided a groundbreaking approach to treatment by defining human sexual response into four distinct phases: excitement, plateau, orgasm, and resolution. This article details the Masters and Johnson therapy model and its core principles.

Understanding the Masters and Johnson Sexual Therapy Model

The Masters and Johnson sexual therapy model marked a significant advancement in treating sexual problems, emphasizing the physiological changes individuals experience. Their approach was built upon several key considerations:

Human sexuality is a natural process, controlled by a series of reflex responses.
Therapy should aim to facilitate these fundamental reflex responses.
They rejected the notion that sexual dysfunction is solely a result of a mental disorder.
Couples should understand that sexual intimacy is not the sole foundation of a relationship.
Blaming either partner for sexual dysfunction is counterproductive and avoided.
Sexual dysfunctions were viewed as learned behaviors, shaped by experience.

Implementing the Masters and Johnson therapy model requires adherence to specific guidelines:

The process begins with a comprehensive, individualized assessment for each couple.
Treatment focuses on the couple’s relationship dynamics, considering all relevant factors.
This model typically follows a brief, intensive 15-day residential format.
It’s an integrative therapy model, accounting for social, biological, and psychological factors.
Active collaboration from both partners is crucial for treatment success.

Phases of the Masters and Johnson Sexual Therapy

The therapy itself is structured into distinct phases, each designed to address specific aspects of sexual health and couple interaction.

1. Evaluation and Diagnosis Phase

The initial three days of treatment are dedicated to evaluation and diagnosis. This involves:

Individual and joint interviews with both partners.
Thorough medical examinations.

During this phase, therapists clarify the therapy’s foundation, provide essential sexual education, and prohibit sexual activity outside of authorized therapeutic exercises. The phase concludes with a detailed analysis, diagnosis, and discussion with the couple regarding their specific issues and the therapy’s subsequent steps.

2. Sensate Focus Phase

In this phase, couples engage in sensate focus exercises, designed to help each partner explore and identify body areas that are most pleasurable when stimulated. The goal is to enhance awareness of sexual response and foster mutual satisfaction. This phase also emphasizes improving communication between partners, encouraging them to openly express desire and affection.

3. Specific Phase

Following successful evaluation, diagnosis, and sensate focus work, the specific phase implements tailored techniques to address the identified sexual dysfunction. The treatment program is highly individualized, adapting to the couple’s unique needs and the specific nature of their dysfunction, which might include issues like premature ejaculation, erectile dysfunction, hypoactive sexual desire disorder, orgasmic disorder, vaginismus, or dyspareunia.

Phases of the Sexual Response According to Masters and Johnson

Beyond the therapy model, Masters and Johnson also delineated the distinct physiological stages of the human sexual response cycle.

1. The Excitement Phase

The first phase involves physiological changes indicating a response to sexual stimulation, whether physical or psychological.

In women, vaginal lubrication begins, the clitoris swells, and breast size may increase due to vasocongestion (increased blood flow).
In men, penile erection occurs due to vasocongestion, testicles elevate, and the rectum may experience irregular contractions.
Both sexes may experience a “sex flush” (skin reddening), increased blood pressure, and an elevated heart rate due to heightened blood circulation and body temperature.

2. The Plateau Phase

This phase marks a significant increase in sexual tension and intensified vasocongestion.

In men, the penis reaches maximum erection, testicular size increases, and rectal contractions continue.
In women, vaginal walls contract, the clitoris retracts, and the uterus enlarges. Involuntary rectal contractions may also begin.
Both partners exhibit a continuation of the sex flush, with further increases in blood pressure and heart rate, and accelerated respiration.

3. The Orgasm Phase

The third phase is characterized by an explosive, involuntary discharge of neuromuscular tension as sexual stimulation reaches its peak intensity, resulting in the climax and greatest pleasure.

In women, the orgasmic platform contracts 5 to 12 times at intervals of approximately 0.8 seconds, accompanied by involuntary contractions in other muscle groups, including the anal sphincter.
In men, the penis experiences contractions leading to ejaculation, driven by contractions of the pelvic and urethral muscles, also accompanied by rectal contractions.
During orgasm, both partners continue to experience elevated blood pressure, heart rate, and respiratory rate.

4. The Resolution Phase

The final phase involves a progressive loss of sexual tension, as both partners return to their pre-excitement state.

In men, a refractory period follows orgasm, during which a full sexual response is not typically possible. This period varies widely among individuals, usually lasting between 15 and 30 minutes, and generally increases with age.
In women, the signs of vasodilation gradually disappear after orgasm. Notably, women do not experience a refractory period and are capable of experiencing multiple orgasms in a shorter time frame.