Introduction It is a popular belief that being physically attractive is of greater importance for women than for men in today�s society, particularly in attracting the opposite sex. Several studies have found support for this difference in the context of dating and mate selection. In an early study, Strauss (1946) asked what traits would be most critical in a marriage partner and found that males rated physical attractiveness significantly higher than females did. Coombs and Kenkel (1966) asked a similar question about potential dating partners and found a similar gender difference. Harrison and Saeed (1977) examined a series of advertisements and found that females were more likely than males to emphasize their physical attractiveness. In a study conducted by Nevid (1984), subjects were asked to rate various physical, social, and personality characteristics in terms of their importance in determining choice of romantic partners. The results of this study indicated that males placed greater importance on characteristics such as weight, body shape, and overall build, while females emphasized characteristics such as warmth, honesty, and fidelity. On the basis of this frame of reasoning, it can be appropriate to infer that women are socialized to believe that to be an adequate sex partner, they must conform to societal norms regarding physical attractiveness. As a result, women are continually faced with meeting the demands prescribed on them through society. They are expected to present themselves as attractive, appealing, sexy individuals.

Accordingly, the low sexual esteem that may ensue from the pressures of conforming to the dictates of society among women is an often overlooked phenomenon It is abundantly clear that physical attractiveness among women serves a puissant element in sexual relationships. This emphasis on physical attributes continues as relationships become more solidified, and couples are married. (Margolin and White, 1987). Contrary to the belief that the component of physical attractiveness declines in value through years of marriage, it has been demonstrated that this is clearly not the case. As marriages and spouses age, women may live with the increasing likelihood of comparisons and competition from women who are much younger than themselves (Margolin and White, 1987). Consequently, the relationship of physical attractiveness to marital sexuality and its immediate impact on cognitive processes serves as a vital component in amalgamating a synthesis for sexual dysfunction in women. Rationale Many factors have been identified in the development of sexual dysfunction, ranging from communication problems, sexual misinformation, deleterious relationships, and faulty learning processes. The focus of this paper, however, is directed to an expansion of the original concept of spectatoring, proposed by Masters and Johnson (1970). Upon acquiring a basic level of comprehension on sexuality and its impact on relationships, I found myself speculating about plausible contributing factors to sexual problems between couples. In becoming more familiar with Masters and Johnsons� (1970) work, I am motivated to unveil the affect of cognitive distractions (specifically, the impact of self-focus) on the level of satisfaction in sexual relationships.

The Concept of Spectatoring Masters and Johnson (1970) originated the concept of spectatoring. Spectatoring, or excessive self-focus, refers to an inspection and monitoring of one�s own sexual activity. According to Masters and Johnson (1970), �when cognitive interference occurs, it leads to arousal of the autonomic nervous system, thereby producing a negative emotional state that is not usually synonymous with sexual arousal and pleasure.� Based on these fundamentals, it is postulated that anxiety about sexual performance, which may stem from an inward, self-focus on one�s abilities and appearance, is the most important immediate cause of sexual dysfunction. Carver (1979) conceptualized self-focus in the following way: When attention is self-directed, it sometimes takes the form of focus on internal perceptual events, that is, information from those sensory receptors that to react to changes in bodily activity. Self-focus may also take the form of an enhanced awareness of one�s present or past physical behavior, that is, a heightened cognizance of what one is doing or what one is like. Alternatively, self-attention can be an awareness of the more or less permanently encoded bits of information that compromise, for example, one�s attitudes. It can even be an enhanced awareness of temporarily encoded bits of information that have been gleamed from previous focus on the environment; subjectively, this would be experienced as a recollection or impression of that previous event. In Carver�s classification of this construct, the individual focuses on internal information as opposed to external information. For instance, during sexual interaction, the mode of attention is directed to body image, and perception levels of attractiveness, rather than focusing on the current sexual act.

Embedded in Barlow�s (1986) theoretical model of spectatoring is the notion that �subjects who maintain negative conceptualizations about their bodies are expected to be more sexually avoidant than subjects who do not focus on negative aspects of their bodies.� Barlow (1986) designed a working model of sexual dysfunction that differentiated sexually functional subjects from sexually dysfunctional subjects. Essentially, five factors were identified in comparing the two opposing groups (functional vs. dysfunctional) These factors included differences in affect during sexual stimulation, differences in self-reports of sexual arousal and perception of control over arousal, distractibility during sexual stimulation, and differential sexual responding while anxious. These findings suggest a cognitive interference process interacting with anxiety, is responsible for sexual dysfunction. Research on Self-focus in Relation to Sexual Dysfunction Past research studies have documented the role of cognitive interference in sexual arousal. Henson and Rubin (1971) demonstrated that individuals could suppress erections while watching erotic films if asked to do so. When this suppression occurred, the mechanism by which individuals suppressed erections was self-distraction, or a shift in attention. In attempting to capture an instrument to measure sexual- esteem, Snell and Papini (1989) designed three aspects of human sexuality: sexual esteem, sexual depression, and sexual preoccupation. For the purposes of this paper, the factor of self-esteem will be addressed. Sexual esteem was defined as �a positive regard for and confidence in the capacity to experience one�s sexuality in a satisfying and enjoyable way.� (Snell and Papini, 1989). As defined in this manner, sexual-esteem deals with interpersonal sexual concepts. It is posited that the source of all three of these sexual tendencies (specifically, sexual esteem) is assumed to be prior learning experiences related to human sexuality. Interestingly enough, this finding lends support to meeting the ideals of physical attractiveness inherent in our attitudes pertaining to sexuality. In a recent study, Faith and Schare (1993) attempted to examine the relationship between excessive self-focus on bodily appearance and sexual experiences. It was hypothesized that individuals who persistently evaluated their appearance negatively would tend to be sexually avoidant, and as a result, less sexually experienced.

The results of the study confirmed that negative body image was related to lower levels of sexual experience. In a recent study aimed at examining the effects of cognitive distraction on sexual arousal in women, Dove and Wiederman (2000) found statistically significant results on the basis of four outcome variables: sexual esteem, orgasm consistency, pretending orgasm, and sexual satisfaction. Their findings indicate that women who reported greater cognitive distraction during sexual interactions reported lower sexual esteem, less sexual satisfaction, less consistent orgasms, and a higher prevalence of pretending orgasm with a partner. More importantly, when other variables that are thought to influence women�s appraisal of their sexual experiences were controlled, cognitive distraction during sexual activity still had a statistically significant relationship with how satisfied women were with their sexual experience and how they viewed themselves as sexual partners. The concept of spectatoring described by Masters and Johnson (1970), and Barlow (1986) has also been proposed as an explanation in level of sexual experience. Faith and Schare (1993) hypothesized that individuals negatively focused on their bodily appearance would tend to be sexually avoidant and would therefore show lower levels of sexual experience than less self-focused individuals. Therapeutic Implications According to Master�s and Johnson, the major task of therapy lies in overcoming performance fears and feelings of sexual inadequacy. Some significant forms of treatment revolve around developing more effective communication skills, practicing specific behaviors (i.e.:sensate focus exercises), and taking a closer look on the interactions within a couple and the functions of the sexual problems in the relationship (systems therapy). The fact that several studies have investigated the veracity of the interplay between cognitive distractions and sexual relationships, and continues to be regarded as an important etiological factor in sexual dysfunction requires us as therapists to incorporate some form of cognitive treatment in couples suffering from sexual dissatisfaction. Application of Self-focus For the purposes of demonstrating the importance of cognitive therapy in sexual relationships, let us consider the following example. Mary and Tom are seeing a therapist concerning their sexual experience as a couple. Furthermore, Tom is experiencing difficulties with premature ejaculation. A common approach to this situation would include the technique of sensate focus. An essential guideline of this exercise involves sensual touching in the context of both partners remaining nude in each other�s presence. Undiscovered by the therapist, Mary is ashamed of her body and doesn�t feel comfortable exposing herself under such terms.

Mary is a shy, reserved woman who will try anything to help the sexual intimacy between herself and her husband, so she follows according to the plan. When they come in for the following session, Tom bursts with anger complaining about the ineffectiveness of the exercise. What has occurred here is an example of a woman who is so intensely self-focused on her poor body image, and low sexual-esteem that she is unable to enjoy the intimacy of sex with her husband. As the sessions progress, Mary hesitatingly reveals to the therapist that she cannot focus on pleasure because she is distracted by other things. �How can I relax knowing that my body looks like this? I hate the way I look; and I know that I am unappealing.� Based on Mary�s statement about herself, she views herself negatively and holds the belief that others have the same assumptions of her. In this case, it becomes necessary to explore Mary�s maladaptive cognitive distortions. It would be beneficial for the therapist working with this couple to demonstrate to Mary how her irrational thoughts have contributed to the sexual difficulties. Consequently, the previously held cognition�s are changed into more appropriate ones. For instance, �I always believed that I was ugly because people made fun of me when I was growing up, but I know now that I am an adult and that is no longer the case.� By altering and shifting the focus from an internal to external locus of control, Mary forms new ways of thinking, in turn leading to more opportunities for sexual intimacy. Plausible Therapeutic Strategies Distractions can be used effectively as a therapeutic strategy for the control of emotional responding. Therapeutic techniques such as thought stopping and covert sensitization, may be useful in working with women who have a tendency to self-focus and remain cognitively distracted in sexual interactions. The reliability and validity of the Sexuality Scale (Snell and Papini, 1989) indicate that it might be advantageous when working with couples or individuals who are suffering from sexual dysfunctions. One method of incorporating the items from the scale can be to present the client(s) with a questionnaire.

Or the therapist can verbally pose the questions, if the therapeutic alliance has been firmly established. Some of the items derived from the sexual-esteem scale include: �I am a good sexual partner�. �I am not very confident in sexual encounters�. � I would rate myself low as a sexual partner.� Clients can then respond with one of the following five options: agree, slightly agree, neither agree nor disagree, slightly disagree, or disagree. Sexual adjustment and satisfaction are important features of personal well-being and satisfaction with intimate relationships. In this regard, the importance of cognitive processes and the utility of applying concepts from cognitive psychology to human sexuality cannot be disregarded. Granted, numerous studies indicate other valid, sound, concrete contributing factors of sexual dysfunction. Nevertheless, these findings should not discount the significance of the role of self-focus in sexual relationships. Implications for Future Research The field of cognitive psychology has offered much insight and elucidation in furthering our understanding of the capacity our internalizations have in our sexual relationships. However, much research is needed to gain a richer understanding of the influence that self-focus plays on human sexuality. The limited number of studies available to date are not sufficient in providing therapists with adequate information regarding the applicability of Masters and Johnsons� (1970) original concept of spectatoring. Much remains to be investigated in terms of the prevalence, level of dysfunction, and specific treatment modalities in working with individuals who have a tendency to self-focus. Without further exploration we are devoid of reaching outcome goals with clients in the therapeutic process. In the interim, let us keep in mind the cognitive variable, self-focus and its crucial role in human sexuality, The Role of Self-Focus as a Function of Significance In Sexual Dysfunction

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