19 May


A sex counseling model is frequently being recommended by CME courses for physicians, under the rubric of “optimizing” care when using PDE-5 treatments. As discussed earlier, multiple MHPs have attempted to raise awareness of the importance of psychosocial factors in the etiology and treatment of ED (15,17,20,32). However, this sex counseling model will apply to clinicians treat- ing both men and women for the entire range of SDs, not merely those treating ED. Clinician difficulty with either moderate or severe psychosocial complexity would lead to appropriate referral and presumably the use of the multidisciplinary team model.

A recent article, “Sex Coaching for Physicians” provided a comprehensive discussion for nonpsychiatric physicians on incorporating psychotherapy into their office practice to enhance sexual pharmaceutical efficacy (20). The article emphasized augmenting pharmacotherapy with sex therapy when treating ED specifically, or SD generally. Although intended for the nonpsychiatric physician, the article served as a good model for any clinicians interested in inte- grating use of sexual pharmaceuticals with their sex therapy practice, using a multidisciplinary model. That multidisciplinary approach constitutes the second alternative for “combination treatment” and will be addressed more fully, later in this chapter. The following section on counseling, incorporates key issues from the article in addition to other tips, helpful to clinicians counseling SD patients.

Clearly, clinicians treating SD must consider the psychological and beha- vioral aspects of their patient’s diagnosis and management, as well as organic causes and risk factors. Integrating sex therapy and other psychological tech- niques  into  their  office practice  will  improve  effectiveness  in  treating  SD. Psychological forces of patient and partner resistance, which impact patient compliance and sex lives beyond organic illness and mere performance anxiety must be understood. The following key areas of therapeutic integration will be highlighted:  Focusing  the  sex  history;  sexual  scripts  and  pharmaceutical choice;  “follow-up”  and  “therapeutic  probe”  to  manage  noncompliance; partner issues; relapse prevention; and referral.

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