Integrating Sexual Medicine with Sex Therapy

A Collaborative Treatment Approach

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It’s no secret that human sexuality is an intricate interplay of one’s physiological responses, emotional processes, and relationship issues. Sexual dysfunction is a quality of life problem that may affect an individual’s desire for sexual activity, ability to become sexually aroused, capacity to reach orgasm, or to experience sexual activity without pain.

Many individuals who experience sexual difficulty wait months, sometimes years before seeking help from a medical or psychotherapy professional. Others remain too embarrassed or ashamed to ever seek treatment for sexual problems, reluctant to disclose and discuss intimate or uncomfortable information. Instead, they remain silent, trusting that their issues will resolve themselves without professional attention, often at the expense of their health, self-esteem and, most certainly, their intimate relationship.

Those who are experiencing trouble in the bedroom may make their first contact with a physician seeking a pill, cream, or lotion in hopes of quickly improving their sexual functioning. After a comprehensive evaluation, the physician may identify a cause, or a more significant health concern, and prescribe a course of treatment. Although a prescription may provide some relief from their symptomology, it does nothing to address what else may be going on emotionally or psychologically within the individual and their relationship.

In other instances, the physician might determine that the symptom does not have a biological origin and conclude that the sexual problem may be best addressed through psychotherapy with the individual and/or couple. The physician then dialogues with the patient and makes an appropriate referral to a mental health professional that has specialized training in the field of sex therapy.

Sex therapists are mental health clinicians who have completed advanced, specialized coursework in the areas of diagnosis and treatment of sexual disorders, human sexuality, and relationships. They work collaboratively with physicians to treat a broad range of difficulties related to sexuality, including erectile dysfunction, rapid ejaculation, vaginismus, anorgasmia, and dyspareunia. Sex therapy can also address individual issues related to sexual identity, trauma, sexual orientation, problematic sexual inhibitions, undesirable sexual habits, as well as desire discrepancies in couples. Although the discussions between the couple and the therapist in the context of sex therapy are of an intimate nature, the therapy itself never involves physical examination or contact, of any sort, between the therapist and the patient.

Frequently, individuals and couples bypass a physician’s office and make their initial contact with a psychotherapist, seeking treatment for relationship difficulties and intimacy issues. The therapist begins their work by obtaining a comprehensive psychosexual history from the patient and/ or couple, whereby the sex therapist learns about the origin of the symptoms and related information regarding emotions, past history, and current sexual functioning. Through this process, the therapist may discover emerging or persistent symptoms of a sexual dysfunction, which may or may not be a symptom of an underlying disease. In order to rule out a biological cause, such as diabetes, neurological disorders, hypertension, endocrine disorders, etc., the therapist refers the patient to a competent physician for a proper medical diagnosis and course of treatment. Once a diagnosis has been made, or physiological etiology of the dysfunction has been ruled out, the therapist continues their work with the individual or the couple through talk therapy, assigning specific sexual homework tasks to be completed in the privacy of the patient’s home.

By developing collaborative relationships between the sexual health provider and the sex therapist, patients may increase their compliance with prescribed courses of treatment. Those patients, who require the use of prescription drugs such as SSRI’s, antihypertensives, antipsychotics, and anitepileptics, may not use the medication as recommended by their physician due to some adverse sexual side effects. A physician can take a pro-active approach with these individuals by discussing the possibility of sexual side effects and recommend a consultation with a sex therapist to explore alternative practices that may alleviate these difficulties while still maintaining the patient’s prescribed course of treatment.

It is important to recognize that not all sexual dysfunction has an organic cause, yet all sexual dysfunction takes a psychological, emotional, and relational toll on the individual and couple. Whether the patient initially presents in the medical office or in the therapy office, the perceived competency of the providers, as well as the level of trust the patient may feel toward the physician and therapist, can be enhanced by taking a multi-disciplinary approach to the diagnosis and treatment of their sexual dysfunction.

Valerie Areaux, MS, LMFT, owns and operates Bluegrass Family therapy, LLC with offices in Lexington and Danville, Kentucky. She is a Licensed Marriage and Family Therapist with nearly 20 years of clinical experience providing treatment to individuals and couples with relationship and intimacy issues. She is currently completing a clinical program in Sex Therapy through the Florida post-graduate Sex Therapy Training Institute located in palm Beach, Florida.