Combination Therapy for Sexual Dysfunction Integrating Sex Therapy and Sexual Pharmaceuticals

We know, clinically, that many PDE-5 nonresponders will be restored to sexual health through a CT integrating sex therapy and sexual pharmaceuticals. Yet how do we conceptualize such a model so that standard treatment algorithms could be stretched to incorporate this concept? The answer is twofold. We need a schema for understanding psychosocial obstacles (PSOs) to successful treatment, integrated into a model that executes that understanding.

Combination therapy is the therapeutic modality of choice for any SDs. Combination therapy refers to a concurrent or step-wise integration of psychological and medical interventions. We have previously described developing adherence for this approach to ED, with enthusiasm growing within the FSD treatment community (36). Combination therapy is already being recommended for PE, and is likely to be recommended for the full range of ejaculatory disorders (41). Although desire disorders for men and women have a strong psychosocial cultural component, there is little doubt that sexual "desire" has biological underpinnings and is likely to be distributed on the same bell-shaped distribution curve as other human characteristics. This simply means that all SDs have a bio-psychosocial basis and that treatment must incorporate medical and psychological dimensions. Without adequate desire, motivation, and realistic expectations, treatment outcome is likely to be disappointing and with high discontinuation rates. Medical interventions do not motivate the sexually reluctant patients or partners to try treatment, nor do they help overcome psychological obstacles to success. Reciprocally, it would constitute malpractice to only focus on psychological factors to the exclusion of all possible organic etiology for an individual seeking assistance. Then, how can an ethical and motivated clinician proceed?

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