Monday, December 12, 2005

Sexual Problems: Are They Medical or Psychological?

by Leonard DeRogatis, Ph.D

Among experts and commentators who write about sexual problems, I find some who decry the “medicalization” of sex and the abandonment of psychological approaches to the diagnosis and treatment of sexual problems.

These critics argue (correctly) that sexual functioning and relationships are much more than nerve transmission and the search for a magic pill; that medical treatments of sexual problems that don’t address psychological and relationship conflicts are shortsighted and narrow; and that a sexual relationship comprises much more than a man’s success in achieving an erection or a woman’s ability to reliably lubricate her vagina. According to some of these critics, medical practitioners believe that drugs and drugs alone are the cure-all for problems in a couple’s relationship. Those with a more conspiratorial bent invoke “big pharma,” motivated by its desire to maximize drug sales, as the agent behind the medicalization of sex.

I believe these critics are misinformed and inaccurate in their portrayals of pharmacologic approaches to treating sexual dysfunctions. First, we need to remember that medical practitioners are trained and licensed to administer medical interventions. Most are not psychotherapists or marriage counselors. Their mandate is to focus on the medical causes of the conditions they treat, and to refer their patients to other specialists if it turns out that the cause is more complex or if the condition does not respond to medical intervention alone.

Second, not every sexual problem, particularly one that is severe and acquired rather than chronic, has a psychological or relational component. Problems due to androgen insufficiency, diabetes, and vascular problems have an exclusively medical cause. I’m sure that all of us could benefit from a bit of marital advice every now and then, but it’s unrealistic to argue that every condition requires comprehensive psychological as well as medical treatment.

Third, the medications these critics condemn so bitterly -- PDE5 inhibitors like Viagra and Levitra -- work. Extensive clinical trials of these drugs have demonstrated repeatedly that they are effective and safe.

Fourth, the argument that pharmacologic approaches are too narrow is a straw man. A man who gets a prescription for Viagra, for example, is not precluded from being referred for sex therapy, individual psychotherapy, or couples counseling. No intelligent health care provider would advocate treating relationship problems with a drug.

I believe the critics who disparage medical therapies for sexual problems have personal agendas that are not based on science or facts. Their pronouncements muddy the waters and discourage people who could benefit greatly from medical treatment for their sexual dysfunction.

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