Sexual Tipping Point® A Framework to Achieve Sexual Balance

The Sexual Tipping Point® Variable Control model illustrates whether a man or woman is “turned on" or "turned off,” with the simultaneous capability of depicting all the complex multifaceted factors intrinsic to understanding sexual response. The Sexual Tipping Point® (STP) depicts a person’s moment to moment sexual response (or lack of), as regulated by the interaction of their constitutional sexual capacity with biomedical, psychosocial and cultural determining factors. An individuals STP differs from one experience to another, based on the proportional impact of one factor dominating as others recede in importance. The STP model can illustrate both the intra and inter-individual variability characterizing sexual response and its disorders for both men and women. The below figure illustrates the STP model's fundamental elements and will familiarize you with the model's graphic representations.

Source: MAP Education & Research Foundation, used with permission.

Source: MAP Education & Research Foundation, used with permission.

Two pans labeled “Excitation” and “Inhibition” each hold two pairs of interconnected containers. The containers are labeled “M” (Mental) and “P” (Physical) but are bridged together by an “A” (And), recognizing that the line between mental and physical has become progressively more porous with the greater understanding of how thoughts become translated into biochemical/electrical components. The Mental And Physical containers hold all known exciting (+) and inhibiting (-) factors that influence a sexpositive or sex negative response. Dimmer switches illustrate each of these billions of factors that are variably charged and with variable valence. Some additional factors may be neutral (=) and others are not yet discovered (?).

Previously, the STP was labeled as one of a number of “Dual Control” biopsychosocial models. Instead, it should be thought of as a “Variable Control” model, as it displays both variable polarity (different poles, plus vs. minus) and valence (degree, intensity) as shown below. The reasons for this change reflected advances in our biological, psychosocial, and technological knowledge about the human body. Nature is not black and white. Our human “turn-ons" and turn "offs” are best understood as continuous and not discrete categories. All these factors are more like variable micro-switches (dimmers) rather than dual control off/on switches. Simple off/on switches fail to fully capture the sexual dynamism and the spectrum of biological variability. Valence and polarity for any given factor can change over time, for a variety of different reasons. Excitement can increase or decrease at any time and the same is reciprocally true of inhibition. In other words, any person’s sexual factors (dimmers) may be “dialed up or dialed down” from their previous charge and weighting. The dimmer analogy allows for easy explanation and understanding.

The STP is the net sum of all Mental And Physical factors, displayed on a balance scale labeled with a Gaussian (normal) distribution curve that spans from excitation to inhibition ("Hot or Not"). So, each factor's dimmer switch setting contributes to the STP’s dynamic representation of an individual’s manifest sexual response at any moment in time. The STP is easily used to explain etiology and highlight treatment targets for change. Once mistaken beliefs and other anti-sexual thoughts are recognized for their contribution to sabotaging sexual success, hope can be instilled by using the STP model to explain how a sexual problem’s causes once identified, can then be fixed

The Sexual Tipping Point® Model above is illustrated in a neutral position. Source: MAP Education & Research Foundation, used with permission.

The Sexual Tipping Point® Model above is illustrated in a neutral position.
Source: MAP Education & Research Foundation, used with permission.


Michael Perelman

MICHAEL A. PERELMAN, Ph.D.

Michael@mapedfund.org

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, for over 30 years. That program is the longest running sex therapy case conference in the world, providing continuing education for its graduates and guests.  A National Institute of Health Fellow, in 1976 he wrote the first sex therapy dissertation in Columbia’s history. Dr. Perelman was Chief Intern at Duke University Medical Center, followed by a Post-Doctoral Fellowship studying sex therapy with Helen S. Kaplan at NY Presbyterian Hospital.

 

In 2012 he founded the MAP Education and Research Foundation a 501(c) (3) public charity, that emphasizes a biomedical-psychosocial and cultural approach to the diagnosis and treatment of sexual disorders, using its Sexual Tipping Point® Model. The Foundation grants STP Awards for best abstract/presentations delivered at sexual health care professional meetings.

 

As an international leader and member of over 25 professional associations, Dr. Perelman served on several of their boards of directors and was the President of The Society for Sex Therapy and Research (SSTAR).  He was elected a Fellow to the Sexual Medicine Society of North America (SMSNA), the Society for the Scientific Study of Sex (SSSS), , and the International Society for Study of Women’s Sexual Health (ISSWSH).  He was appointed to the Sexual Function Advisory Council of the American Urological Association (AUA), the Standards Committee of the International Society for Sexual Medicine (ISSM), and both the American Psychiatric Association’s DSM-V and DSM 5TR Task Force as an Advisor to the Sex/GID Work Group.

 

In 2015, the Society for Family Psychology of the American Psychological Association (APA) presented him with their Award for Excellence in Teaching. The American Association of Sex Educators, Counselors, and Therapists (AASECT) certifies him as a sex therapy diplomate, supervisor, sex educator, sex counselor, and honored him with their 2012 Award for Professional Standard of Excellence and their 2019, Integrative Sex Therapy Award. In 2021 the University of Minnesota Medical School’s Department of Family Medicine and Community Health’s Program in Human Sexuality selected him as a “Distinguished Sexual and Gender Health Revolutionary.” 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). In 2025, he was named, “Honorary Member” of the International Society for Study of Women’s Sexual Health (ISSWSH). In 2026 ISSWSH presented him with their Lifetime Achievement Award, and he also received the Society for Health Psychology (APA Division 38), 2026 Excellence in Clinical  Health Psychology Award.

           

His co-edited, Management Of Sexual Dysfunction In Men And Women: An Integrated Approach, was published in 2016. In 2012 he became the Editor in Chief, for Springer’s Current Sexual Health Reports, and now is Emeritus Editor in Chief. He serves on several publications’ Board of Directors as a consulting editor, or as a reviewer. He has published over 70 peer reviewed articles, countless abstracts, posters, and over 25 chapters in sexual medicine texts, along with over 300 invited presentations.  His invited Blog for Psychology Today is called the “Sexual Tipping Point.” Dr. Perelman 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. Dr. Perelman has conducted clinical trials, served on dozens of industry advisory boards and speakers’ bureaus, as well as providing expert witness consultations.  His work in sex and marital therapy is often featured in the media.