Psychological and Interpersonal Dimensions of Sexual Function and Dysfunction

Abstract

Introduction There are limited outcome data on the efficacy of psychological interventions for male and female sexual dysfunction and the role of innovative combined treatment paradigms. Aim To highlight the salient psychological and interpersonal issues contributing to sexual health and dysfunction; to offer a four-tiered paradigm for understanding the evolution and maintenance of sexual symptoms; and to offer recommendations for clinical management and research. Methods An International Consultation assembled over 200 multidisciplinary experts from 60 countries into 17 committees. The recommendations of committee members represent state-of-the-art knowledge and opinions of experts from five continents were developed in a process over a 2-year period. Concerning the Psychological and Interpersonal Committee of Sexual Function and Dysfunction, there were nine experts from five countries. Main Outcome Measure Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate. Results Medical and psychological therapies for sexual dysfunctions should address the intricate biopsychosocial influences of the patient, the partner, and the couple. The biopsychosocial model provides a compelling reason for skepticism that any single intervention (i.e., a phosphodiesterase type 5 inhibitor, supraphysiological doses of a hormone, processing of childhood victimization, marital therapy, pharmacotherapy of depression, etc.) will be sufficient for most patients or couples experiencing sexual dysfunction. Conclusions There is need for collaboration between healthcare practitioners from different disciplines in evaluation, treatment, and education issues surrounding sexual dysfunction. In many cases, neither psychotherapy alone nor medical intervention alone is sufficient for the lasting resolution of sexual problems. Assessment of male, female, and couples’ sexual dysfunction should ideally include inquiry about: predisposing, precipitating, maintaining, and contextual factors. Treatment of lifelong and/or chronic dysfunction will be different from acquired or recent dysfunction. Research is needed to identify efficacious combined and/or integrated treatments for sexual dysfunction.

Sexual functioning in older adults

“…Not only is depression a risk factor for sexual dysfunction [20], the medications associated with treating it, particularly selective serotonin reuptake inhibitors, are associated with sexual dysfunctions such as anorgasmia, erectile dysfunction, and diminished libido that may persist after medication use is discontinued [21].…”

Application of the Sexual Health Model in the Long-Term Treatment of Hypoactive Sexual Desire and Female Orgasmic Disorder

“…By itself, orgasmic disorder is a common and often straightforward disorder to treat with a number of standard treatment protocols, most notably directed masturbation (Althof et al, 2005;Heiman, 2002;Stinson, 2009). The treatment of orgasmic disorder in the context of two co-morbid sexual dysfunctions, post-traumatic stress disorder, and major depression and in the context of serious abuse, family, relationship and medical problems was not typical and quite challenging-necessitating longterm treatment.…”

“…This treatment promotes attitude, thought, and behavior changes and anxiety reduction through exercises such as directed masturbation, sensate focus (i.e., exercises developed by Masters and Johnson to assist couples experiencing sexual problems), Kegel exercises, communication skills training, systematic desensitization, and sex education (Althof et al, 2005;Heiman, 2002;Stinson, 2009). While ''there are no pharmacological agents proven to be beneficial beyond control,'' several pharmacological agents such as sildenafil, ArginMax, granisetron, and estrogen and testosterone show promise in treating orgasmic dysfunction (Meston, Hull, Levin, Sipski, & Heiman, 2004, p. 242), with sildenafil showing promise with anti-depressant associated orgasmic dysfunction (Nurnberg et al, 2008).…”

The Demise of Sexological Science is Not Imminent in the Face of Sexual Medicine: Commentary on “Will Medical Solutions to Sexual Problems Make Sexological Care and Science Obsolete?”

“…A follow-up study of patients treated with Viagra TM revealed that one-quarter of the sample was unable to sustain initial improvements with the drug, due to difficulty resuming or maintaining their sexual relationship (Pallas, Levine, Althof, & Risen, 1999). Although PDE-5 inhibitors may facilitate better erections, they fail to address key individual and/or couple problems (Althof et al, 2005;Perelman, 2005). Strengthening this statement is evidence suggesting that partner satisfaction and involvement are crucial for treatment compliance and long-term use; men with uninvolved partners are more likely to discontinue the use of medical interventions for ED (Montorsi & Althof, 2004;Riley, 2002).…”