Treatment of sexual disorders in the 1990s: An integrated approach.

Abstract

Marked changes have occurred in the formulation and treatment of sexual disorders in the past 2 decades. Emphasis has shifted to the role of biomedical and organic factors in the etiology of sexual dysfunction, along with the growing use of medical and surgical treatment interventions. Multidimensional assessment models are widely used, particularly in the evaluation of male erectile dysfunction and sexual pain disorders. Integrated treatment approaches have also been developed, as cognitive-behavioral and couples' therapy procedures are increasingly combined with traditional sex therapy techniques. This article reviews existing data regarding the etiology and treatment of male and female sexual dysfunctions. Despite the conceptual and technological sophistication of current approaches, treatment outcome is less than satisfactory in several areas. Further research is needed on the etiology and treatment of sexual disorders.

Ecological Models of Sexual Satisfaction among Lesbian/Bisexual and Heterosexual Women

“…However, as the population became more informed about sexuality and sexual practices, the direction in sex therapy shifted, and in the past two decades, sexual concerns have been approached with increasingly organic or medical treatments (Ragucci & Culhane, 2003;Rosen & Leiblum, 1995). In fact, many individuals with sexual concerns visit their primary care physician rather than a mental health professional for treatment (Ragucci & Culhane, 2003).…”

“…Despite its contextual nature, sexual satisfaction is often considered solely in terms of physiology, based on the medical model of sexual functioning popularized by Masters and Johnson (1970; see also Rosen & Leiblum, 1995). Rarely is sexual satisfaction conceptualized, studied, or treated within the context of a relationship.…”

Empirically supported couple and family interventions for marital distress and adult mental health problems.

“…An intervention, first introduced by LoPiccolo and Lobitz (1972), based on improving sexual skills through directed masturbation training is often considered the treatment of choice for lifelong orgasmic disorder (Rosen & Leiblum, 1995), especially for clients motivated to achieve orgasm via sexual activities with their partners (Leiblum & Ersner-Hershfield, 1977). The treatment protocol is clear and replicable, involving nine sequential steps that include education and self-exploration, directed masturbation, sexual fantasy and imagery, and sensate focus (first individually and then with a partner).…”

“…Zimmer's sample included orgasmic, arousal, and desire disorders, a mixture that is reasonable in light of the high level of comorbidity of the various secondary dysfunctions and the questionable empirical validity of the discrete DSM-IV categories (Rosen & Leiblum, 1995). Adding to the ecological validity of the study, half of the male partners in Zimmer's sample suffered from some form of sexual dysfunction.…”

“…We should note, however, that DSM (revised third edition [DSM-III-R; American Psychiatric Association, 1987] and fourth edi-tion [DSM-IV; American Psychiatric Association, 1994]) categories of sexual dysfunctions have been criticized for lacking empirical validation and conceptual clarity (Rosen & Leiblum, 1995); desire, arousal, and orgasmic disorders often coexist (Segraves & Segraves, 1991). There are additional problems with conceptualizing sexual dysfunctions as discrete entities because comorbidity exists not only within individuals but between partners.…”