Surrogate partner therapy: ethical considerations in sexual medicine.

INTRODUCTION: Surrogate partner therapy (SPT) is a controversial and often misunderstood practice. AIM: The aim of this study was to review the history and evidence-based literature regarding SPT, describe and provide a model for ethical SPT practice, and present two case examples illustrating ethical concerns. METHODS: Literature review and report of clinical experience were the methods used. MAIN OUTCOME MEASURE: Results of literature review and clinical experience were assessed for this study. RESULTS: Sex therapy pioneers Masters and Johnson introduced surrogacy in sex therapy; however, there is a lack of published evidence supporting treatment efficacy and ethico-legal questions have limited the practice from becoming a common intervention. SPT can be an effective intervention that may enhance sexual medicine practice. However, SPT must be offered according to legal, professional, and ethical standards. CONCLUSIONS: Sexual medicine practitioners should consider SPT based on the ethical paradigms offered, and sex therapy practices utilizing SPT should collect and publish outcome data.

The ultra-Orthodox Jewish couple in Israel: an interdisciplinary sex therapy case study.

Treatment for couples presenting with sexual difficulties should consider the context of the couple's lives and their cultural milieu. Practitioners treating couples from traditional and faith-based societies should acknowledge, respect, and be willing to modify treatment to conform to the clients' beliefs. The purpose of this article is to describe the case of a young ultra-Orthodox couple presenting with unconsummated marriage and to illustrate and elucidate the multidisciplinary and culturally sensitive treatment provided.

[Ethical issues concerning surrogate assisted sex therapy].

Sex therapy, by definition, is a couple therapy as well as behavioral therapy by origin. As such, practicing a series of exercises is an essential part of the therapy. Masters and Johnson, in their book "Human Sexual Inadequacy", wrote that "one cannot learn about sexuality in any practical way without actually experiencing intimate behavior with a partner". This ethical approach directed them to develop the therapeutic method of working with surrogate partners, as they thought all people are entitled to receive therapy, if they so wish, including people without partners. Surrogate is a form of mentoring; this is a one-on-one relationship that allows practicing classic behavioral methods such as gradual progress, breaking the task into small goals, onsite feedback, rehearsals, role-play, modifying the environment, etc. The content and the skills that are practiced are related to sexual dysfunction as well as social, couple and intimate skills. The lack of those critical skills prevents the clients from fulfilling their wish to develop social or intimate relationships in which they will be able to accomplish their sexuality. Ethical procedures should be strictly kept in order to protect the clients and the surrogates, in a three-way therapeutic team, working together to reach the goals of the therapy. During the therapy process a weekly meeting is held between the therapist and the client, between the therapist and the surrogate and, only then, between the surrogate and the client. At the end of the therapy process the relationship between the client and the surrogate is terminated, completely. In this article, the authors illuminate the complexity of this therapy process, as well as dealing with some of the ethical issues that are raised. The article also identifies types of patients who can benefit from surrogate therapy.

Surrogate versus couple therapy in vaginismus.

INTRODUCTION: Women who do not have a cooperative partner cannot complete the usual therapeutic process in the treatment of vaginismus, because they cannot progress to the stage of practicing the insertion of the man partner's fingers and the insertion of a penis. AIM: To compare traditional couple therapy with therapy utilizing a surrogate partner. METHODS: The study was controlled and retrospective. Data were obtained from the treatment charts of patients who had come to the clinic for treatment of vaginismus. Sixteen vaginismus patients who were treated with a man surrogate partner were compared with 16 vaginismus patients who were treated with their own partners. MAIN OUTCOME MEASURES: Successful pain-free intercourse upon completion of therapy. RESULTS: One hundred percent of the surrogate patients succeeded in penile-vaginal intercourse compared with 75% in the couples group (P = 0.1). All surrogate patients ended the therapy because it was fully successful, compared with 69% in the couples group. Twelve percent of the couples group ended the therapy because it failed, and 19% because the couples decided to separate. CONCLUSIONS: Treating vaginismus with a man surrogate partner was at least as effective as couple therapy. Surrogate therapy may be considered for vaginismus patients who have no cooperative partner.