Why the Sexual Tipping Point® Model?
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The editorial thread of Current Sexual Health Reports aspires to cultivate a biopsychosocial-behavioral and cultural perspective for the reader that also results in more healthcare professionals embracing the importance of a transdisciplinary approach that integrates counseling with current and emerging medical/surgical techniques for the treatment of male and female sexual disorders (Perelman in Curr Sex Health Rep, 7(1):1–2, 2015). Supporting a related goal in 2011, the author founded the MAP Education & Research Fund, a 501(c)(3) public charity dedicated to educating healthcare providers that sexual health is more than just biology. The Fund’s website, mapedfund.org, was just launched in order to offer the resources of its Sexual Tipping Point (STP) model for free! It remains critical to advance a model that would help students, professionals, and the public alike understand that sex is always both “Mental And Physical.” All the biopsychosocial-behavioral and cultural models of sexual dysfunction provide a compelling argument for sexual medicine treatments that integrate sex counseling and medical and/or surgical treatments. Given the choice of so many different biopsychosocial-cultural models, why embrace the Sexual Tipping Point model? Perhaps, the greatest advantage of the STP model is the ease with which it provides clinicians as well as their patients (and their partners) with a common sense explanation of sexual problems and potential solutions. At Weill Cornell Medicine, when contemplating the clinical need for understanding etiology, diagnosis, and treatment, we find the Sexual Tipping Point both helpful and convenient.
KeywordsSexual tipping point model Sexual dysfunction Dual control models Transdisciplinary approach Integrated treatment approach
The author wishes to thank Barry McCarthy PhD, Alexander Pastuszak MD, PhD, and R. Taylor Segraves MD, PhD, for their helpful suggestions and comments on earlier drafts of this commentary.
Compliance with Ethical Standards
Conflict of Interest
Michael A. Perelman is the Founder of the MAP Educational Fund.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by the author.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 5.Goldstein I, Meston C, Davis S, Traish A. Women’s sexual function and dysfunction. New York: Taylor & Francis; 2010.Google Scholar
- 8.Rosen, R., Janssen, E., Wiegel, M., & Bancroft, J. (2006). Psychological and interpersonal correlates in men with erectile dysfunction and their partners: a pilot study of treatment outcome with sildenafil. Journal of Sex & Marital Therapy.Google Scholar
- 9.Rowland, D. L., Patrick, D. L., Rothman, M., & Gagnon, D. D. (2007). The psychological burden of premature ejaculation. The Journal of Sexual Medicine.Google Scholar
- 11.••Perelman, M. A. (2014a). The history of sexual medicine. In APA Handbook of Sexuality and Psychology, Vol. 2: Contextual Approaches (pp. 137–179). Washington: American Psychological Association. While the biased perspective of an American psychologist is evident, the chapter is an excellent summation of the mid-century to present history of modern sexual medicine.Google Scholar
- 12.Perelman MA. Rehabilitative sex therapy for organic impotence. In: Segraves T, Haeberle E, editors. Emerging dimensions of sexology. New York: Praeger; 1984. p. 181–8.Google Scholar
- 13.Kaplan HS. The new sex therapy. New York: Brunner/Mazel; 1974.Google Scholar
- 14.Masters W, Johnson V. Human sexual inadequacy. Boston, MA: Little, Brown; 1970.Google Scholar
- 15.Masters W, Johnson A, Kolodny L. Textbook of sexual medicine. Boston, MA: Little, Brown; 1979.Google Scholar
- 16.•Perelman, M. A. (2008). Integrated sex therapy: a psychosocial-cultural perspective integrating behavioral, cognitive, and medical approaches. In C. C. Carson, R. S. Kirby, I. Goldstein, & M. G. Wyllie (Eds.), Textbook of erectile dysfunction (2nd ed., , London, England: Informa Healthcare. pp. 298–305). This chapter incorporates the shift from combination treatment to an integrated sex therapy approach.Google Scholar
- 17.Althof SE. Therapeutic weaving: the integration of treatment techniques. In: Levine SB, editor. Handbook of clinical sexuality for mental health professionals. New York: Brunner-Routledge; 2003. p. 359–76.Google Scholar
- 18.•Althof SE. Sexual therapy in the age of pharmacotherapy. Annu Rev Sex Res. 2006;17:116–31. Good update of current status of sex therapy in the new millennium.Google Scholar
- 19.Balon R, Segraves RT, editors. Handbook of sexual dysfunction. Boca Raton: Taylor & Francis; 2005.Google Scholar
- 20.Kaplan, HS & Perelman, M. A. (1979). The Physician and the Treatment of Sexual Dysfunctions. In G. Usdin & J. M. Lewis (Eds.), Psychiatry in General Medical Practice (pp. 1–27). McGraw-Hill Book Company.Google Scholar
- 21.Leiblum, SR [Ed] Principles and Practice of Sex Therapy. (2007). Principles and Practice of Sex Therapy (4th ed.). Eds: SR & RC Rosen New York: Guilford Press. Marwick C. JAMA. 1999; 281:2173–2174Google Scholar
- 22.McCarthy BW. Integrating Viagra into cognitive–behavioral couple’s sex therapy. J Sex Educ Ther. 1998;23:302.Google Scholar
- 24.McCarthy, B. W., & Fucito, L. M. (2005). Integrating medication, realistic expectations, and therapeutic interventions in the treatment of male sexual dysfunction. Journal of Sex and Marital Therapy.Google Scholar
- 25.•Perelman MA. Sex coaching for physicians: combination treatment for patient and partner. Int J Impot Res. 2003;15 Suppl 5:S67–74. Introduced the term “sex coaching” into the literature and first article advocating its utility as an approach for physicians.Google Scholar
- 26.Perelman MA. Combination therapy for sexual dysfunction: integrating sex therapy and pharmacotherapy. In: Balon R, Segraves RT, editors. Handbook of sexual dysfunction. Boca Raton: Taylor & Francis; 2005. p. 13–41.Google Scholar
- 29.Rosen R. Medical and psychological interventions for erectile dysfunction: toward a combined treatment approach. In: Leiblum S, Rosen R, editors. Principles and practice of sex therapy. 3rd ed. New York, NY: Guilford Press; 2000. p. 276–304.Google Scholar
- 30.Kupferman I. Hypothalamus and limbic system motivation. In: Kandel ER, Schwartz JH, Jessell TM, editors. Principle of neural science. 3rd ed. New York: Elsevier; 1991.Google Scholar
- 31.Kaplan HS. The sexual desire disorders: dysfunctional regulation of sexual motivation. New York: Brunner/ Mazel, Inc.; 1995.Google Scholar
- 35.••Bancroft J, Graham CA, Janssen E, Sanders SA. The dual control model: current status and future directions. J Sex Res. 2009;42(2):121–42. Excellent summary of Bancroft et al’s important research on their dual control model. Google Scholar
- 36.•Janssen, E., & Bancroft, J. (2007). The Dual Control Model: The role of sexual inhibition and excitation in sexual arousal and behavior. In E. Janssen (Ed.), The Dual Control Model, The Role of Sexual Inhibition and Excitation in Sexual Arousal and Behavior (pp. 197–222). Indiana University Press.Google Scholar
- 38.••Pfaus J. Pathways of sexual desire. J Sex Med. 2009;6(6):1506–33. Excellent classic article that in an understandable and practical manner describes the complexities of neurobiological pathways of sexual desire.Google Scholar
- 39.Gladwell M. The tipping point: how little things can make a big difference. New York: Little Brown & Co; 2000.Google Scholar
- 40.••Perelman MA. The sexual tipping point: a mind/body model for sexual medicine. J Sex Med. 2009;6(3):227–632. First full description of the sexual tipping point model.Google Scholar
- 41.Perelman MA. Idiosyncratic masturbation patterns: a key unexplored variable in the treatment of retarded ejaculation by the practicing urologist. J Urol. 2005;173(4):340.Google Scholar
- 42.•Perelman, MA, & Watter D (2016a) “Delayed Ejaculation,” in Handbook of Clinical Sexuality for Mental Health Professional [Eds: Levine S, Risen C, Althof S, Brunner Routledge, New York, NYGoogle Scholar
- 43.•Perelman MA, (2016b) “Introduction: Advocating For Transdisciplinary Treatment Of Sexual Dysfunction Employing A Biopsychosocial-Behavioral & Cultural Approach. In Management Of Sexual Dysfunction In Men And Women: An Integrated Approach” [Eds: Lipshultz L, Pastuaszak A, Giraldi A, Goldstein A, Perelman MA, Springer, New York, 2016. This introductory chapter both advocates and summarizes an aspirational transdisciplinary approach to the treatment of sexual disorders for practicing physicians.Google Scholar
- 44.•Perelman MA, (2016c) “Epilogue: Cautiously Optimistic For The Future of A Transdisciplinary Sexual Medicine In Management Of Sexual Dysfunction In Men And Women: An Integrated Approach” [Eds: Lipshultz L, Pastuaszak A, Giraldi A, Goldstein A, Perelman MA, Springer, New York, 2016Google Scholar
- 47.Perelman MA. The sexual tipping point: a model to conceptualize etiology, diagnosis and combination treatment of female and male sexual dysfunction. J Sex Med. 2006;3 Suppl 1:52.Google Scholar
- 49.•Abdo C, Afif-Abdo J, Otani F, Machado A. Sexual satisfaction among patients with erectile dysfunction treated with counseling, sildenafil, or both. J Sex Med. 2008;5(7):1720–6. doi: 10.1111/j.1743-6109.2008.00841.x. Article provides evidence for combination treatment for an international audience.
- 50.Althof, S., Leiblum, S., Chevret-Measson, M., Hartmann, U., Levine, S., McCabe. M., et al. (2005). Psychological and interpersonal dimensions of sexual function and dysfunction. In T. Lue, R. Basson, R. Rosen, F. Giuliano.S. Khory, & M. Montorsi (Eds.), Sexual dysfunctions in men and women (pp. 73–115). Paris: Editions 21.Google Scholar
- 51.••Althof SE, Rubio-Aurioles E, Perelman MA, Rosen RC. Standard operating procedures for taking a sexual history. J Sex Med. 2012;10(1):26–35. Literally state of the art guidance for taking a sex history.Google Scholar
- 53.••Althof SE, Rosen RC. Combining medical and psychological interventions for the treatment of erectile dysfunction. In: Levine SB, editor. Handbook of clinical sexuality for mental health professionals. New York: Brunner-Routledge; 2011. Excellent review of the literature on combination treatments for ED.Google Scholar
- 55.Brotto L, Woo J. Cognitive-behavioral and mindfulness-based therapy for low sexual desire. In: Leiblum S, editor. Treating sexual desire disorders: a clinical casebook. New York: Guilford Press; 2010.Google Scholar
- 56.Goldstein A, Pukall C, Goldstein I, editors. Female sexual pain disorders: evaluation and management. Oxford: Blackwell Publishing; 2009.Google Scholar
- 57.McCabe M, Price E, Piterman L, Lording D. Evaluation of an internet-based psychological intervention for the treatment of erectile dysfunction. Int J Impot Res. 2008. doi: 10.1038/ijir.2008.3.
- 58.•Perelman MA (2014b).“Delayed Ejaculation,” in Principles and Practice of Sexual Therapy 5th edition, [Eds:YM Binik and KS Hall], Guilford Press, New York. Authoritative chapter that integrates the theory and practice of sex therapy for patients suffering from delayed ejaculation using the sexual tipping point framework.Google Scholar
- 60.•Rosen RC, Miner MM, Wincze JP. Erectile dysfunction: integration of medical and psychological approaches. In: Binik YM, Hall KSK, editors. Principles and practice of sex therapy. 5th ed. New York: Guilford Press; 2014. Good summary of various integrated medical and psychological approaches to the treatment of ED.Google Scholar
- 61.Titta M, Tavolini I, Moro F, Cisternino A, Bassi P. Sexual counseling improved erectile rehabilitation after non-nerve-sparing radical retropubic prostatectomy or cystectomy—results of a randomized prospective study. J Sex Med. 2006;3:267–73. doi: 10.1111/j.1743-6109.2006.00219.x.CrossRefPubMedGoogle Scholar