Our team had the great pleasure to welcome Dr. Michael Perelman as our most recent Sex Plus Symposium speaker. The following is a summary taken directly from his PowerPoint presentation. Most of this material is copyrighted by him and can only be used with his written permission, which gratefully he has provided to us.

Dr. Michael A. Perelman is a Clinical Professor Emeritus of Psychiatry and former Clinical Professor of Reproductive Medicine and Urology at Weill Cornell Medicine in NYC. He has directed its Human Sexuality Program (founded by Dr. Helen S. Kaplan) for more than 20 years — the longest-running sex therapy case conference in the world, providing continuing education for its graduates and guests.

As an international leader and member of more than 25 professional associations, Dr. Perelman served on several boards of directors and was the President of The Society for Sex Therapy and Research (SSTAR). The American Association of Sex Educators, Counselors, and Therapists (AASECT) certifies him as a sex therapy diplomate, supervisor, sex educator, sex counselor and CE provider, and honored him with their 2012 Award for Professional Standard of Excellence and their 2019 Integrative Sex Therapy Award. In 2022, the SMSNA presented him with a Lifetime Achievement Award at the combined Sexual Medicine Society of North America/International Society for Sexual Medicine (SMSNA/ISSM).

His co-edited Management Of Sexual Dysfunction In Men And Women: An Integrated Approach was published in 2016. He has published more than 65 peer-reviewed articles, countless abstracts and posters, and more than 25 chapters in sexual medicine texts. He writes an invited Blog for Psychology Today called “Sexual Tipping Point®.”

Dr. Perelman also maintains an independent sex and couples’ therapy practice in both Greenwich, CT, and Manhattan. He is certified by NYS and listed in the National Register of Health Service Providers in Psychology. He has conducted clinical trials and served on dozens of industry advisory boards and speakers’ bureaus. His work in sex and marital therapy is often featured in the media.

Dr. Perelman spoke to our team about premature ejaculation and delayed ejaculation while providing educational materials about the model that he's developed and about obtaining a sex status.

What is the Sexual Tipping Point Model®?

The Sexual Tipping Point® (STP) model is an easy way to visualize both the mental and physical elements of sexual function and dysfunction, which can help facilitate an integrated treatment approach during therapy.

This is important because sex is always both mental and physical. The mind can “turn you on” or “turn you off” and the body can also “turn you on” or “turn you off”. Positive mental and physical factors can increase your sexual response while negative mental and physical factors can inhibit your sexual response.

The dynamic combination of all these factors determines a unique Sexual Tipping Point. The STP also illustrates how an individual factor can deviate from a “normal” range, which can help identify a sexual disorder.

To learn more about how the STP functions, visit Dr. Perelman’s website to walk through the model and view additional resources, along with its history.

Categories of Sexual Function

There are different renderings of sexual characteristics that have been depicted over time.

Sex, like anything else, varies from person to person. Some sexual characteristics and thresholds are normally distributed, like arousal. Others are best described by skewed distribution curves, like hair, eye color and coital ejaculatory latency in men.

In 2006, Jim Pfaus described the STP model in The Journal of Sexual Medicine, which helped bring awareness to how this model works and its application to sex therapy treatment.

A dual-control model, first published by Helen Kaplan, depicts the underlying elements of human sexual motivation, sexual inciters sexual desire dysregulation or sexual suppressors.

There are changes within yourself and between you and your partner in any given situation. One of you may be more turned on or in the mood than the other, or you may be ill and not aroused on a particular night.

What’s important to remember is that the factors contributing to a situation can also change direction. Things like trauma, substance abuse or physical changes in one’s body can contribute to differing sexual arousal and desire. That is why the Sexual Tipping Point® outlined by Dr. Perelman is not a stationary scale.

Physical Factors Affecting Sexual Function

Aging and illness can affect the aspects of sexual function a person may be accustomed to in their lives. An older man may not be able to perform at the level he once could when he was younger and therefore be frustrated.

Neurotransmitters in our brains will affect sexual function on a physical level. For example, increased desire typically involves an increase in dopamine and a decrease in serotonin. Alternatively, anti-depressants will often increase serotonin levels in the brain and therefore and have a negative impact on sexual desire and function.

Things like metabolic syndrome, or obesity, can have a disproportionate impact on sexual response. Often, such physiology may overwhelm or neutralize the most sexually arousing factors for men with this condition.

Mental Factors Affecting Sexual Function

Any traumatic experience can have a lasting effect on sexual function. Rape or a violation of one’s body can result in conditioning a triggered response to future intimate touching. What was once pleasurable may become terrifying and nauseating.

Relationship factors can be bidirectional as well. Often,  a common consequence of relationship strife is diminished desire which can also lead to a withdrawal of affection. The absence of affection can lead to their partner feeling rejected, having negative thoughts about their self-esteem, and questioning their attractiveness.  Alternatively, a man can experience erectile dysfunction after feeling humiliated by their partner. A vicious cycle may emerge as concern with previous sexual disappointments result in a continuation of a sexual disorder.  

Female vs. Male Sexual Function

How much is female and male sexual function — or dysfunction — interdependent?

We often hear that women tend to be more responsive to contextual factors than men, but psychosocial issues impact both genders. While there are differences in male and female there is tremendous overlap between men and women.  

Medical vs. Psychosocial Factors of Sexual Function

While many physicians previously believed that all sexual dysfunctions were a medical (or physical) in etiology, the later view that psychological issues predominated has been replaced by an understanding that both are key to understanding sexual disorders. And it is a fact that both the mental and physical aspects of a person are always involved in any sexual experience.

While perhaps ironic, as many sexual disorders are both caused by as well as cured by medical intervention, yet there is always psychological sequela in both instances.

Cultural and religious differences also come into play and may impact sexual pleasure between two partners. Each culture has a different belief system or set of morals they follow, which can impact sexual function.

Regardless of a person’s beliefs or culture, it’s important to share details with a sex therapist about sexual function or dysfunction in order to receive the best treatment possible. Your therapist should be listening with an open mind and work with you to develop the plan that works best for you and your partner.

Sexual functions are always determined by bio-medical, psychosocial-behavioral, and cultural factors. At any given time, a person’s sexual function is related to how those factors play into each other.

Working with a sex therapist to determine what factors contribute to turning you on or turning you off can help improve your sexual experiences.

In part two of our session with Dr. Perelman, we discuss sex therapy treatment for male sexual dysfunctions related to the Sexual Tipping Point®.