Psychotherapy

O'Carroll surveyed the psychological and medical literature from 1970 to 1989, searching for controlled treatment studies of HSDD. He found eight such reports, two of which involved only men. (Of the other six, two included both men and women as the "identified patient" and four concerned women as the patients together with their partners) (50). His commentary was critical and reflected substantial discouragement in that he found no controlled studies with a homogeneous sample in which psychotherapy was the mainstay of treatment and none which included both drug/hormone treatment and psychotherapy.

Nevertheless, some of what does exist in the literature on the psychotherapy of HSDD in men will be reviewed. Heiman et al. considered studies on the treatment of sexual desire disorders in couples (51). None of the studies involved only men; most referred to the treatment of HSDD in women only, or included reports that referred to both men and women as the "identified patient." Of the three studies that included men with sexual desire difficulties, only one included information concerning diagnostic subtyping (52). The latter investigation reported on a 3-month follow-up of 152 couples in which at least one person had a desire difficulty as part of the presenting complaint. Fifty-eight (38%) of the men had a diagnosis of low sexual desire. Seventeen percent were lifelong and 40% were "global." Numbers of patients were not given in the report. In comparing couples in which either the man or the woman presented with a desire difficulty, the authors concluded that initially there was a lower rate of sexual activity when the man was the "identified patient," that men tended to initiate sexual activity more often, and that men were more likely to have a situational and acquired form of desire difficulty. With a behavioral form of treatment, the authors found at follow-up that significant treatment gains had been made and maintained. In addition, they also claimed that the lifetime/acquired and global/situational distinction "did not predict therapeutic outcome." This latter statement failed to distinguish between couples in which the man or the woman was the identified patient, unfortunate because it is quite conceivable that the distinction has more meaning for one gender than the other.

The review by Heiman et al. described another study involving a 3-year follow-up of 38 couples treated for sexual dysfunction (53). The group included six men identified as having HSDD with or without another sexual dysfunction diagnosis. Thirty-three percent of all the men had a "notable health problem" (it was unclear how many of the six men with HSDD were in this group). In spite of the fact that a diagnostic subtyping system was adopted, it was inexplicably not included in the report. A behavioral form of treatment was used and the results were reported separately for men and women. The authors concluded that "the diagnostically relevant items (that were measured), that is, desire for sexual contact and frequency of sexual contact, clearly demonstrate a lack of sustained success for both men and women."

The Heiman et al. report also included a study by McCarthy of (i) 20 couples in which the results for the men and women were not separately stated and (ii) eight men without partners of whom many reported improvement but the original problems were quite unclear (the example of HSDD given in the report was apparently a result of another sexual dysfunction) (54).

O'Donohue et al. surveyed the sex-related literature on the psychological treatment of male sexual dysfunctions (55). They explicitly excluded studies that relied only on medical intervention. In a clear statement concerning the treatment of sexual desire problems, the authors concluded that "no controlled treatment-outcome studies were found for the treatment of... sexual aversion disorder and hypoactive sexual desire disorder... in men."

Several studies in the O'Donohue review had a mixture of diagnoses and some included men with HSDD. In one such group the results were not reported separately for men and women. Another looked at 40 couples in which the men experienced erectile dysfunction and/or loss of sexual interest, and compared the effectiveness of three treatments: weekly couple counseling, monthly couple counseling, and T (56). Subjects were divided into two groups, with high or low levels of sexual interest. Each group was randomly allocated to (i) testosterone or placebo therapy and (ii) weekly or monthly counseling. Results indicated no statistically significant group differences in initial clinical ratings and "substantial relapse between the first and second follow-up in the erections ratings and sexual interest ratings." In addition "the frequency of sexual thoughts at the second follow-up were (statistically) significantly greater in the placebo group."

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