Psychological and interpersonal dimensions of sexual function and dysfunction.
BACKGROUND
There are limited outcome data on the efficacy of psychological interventions for male and female sexual dysfunction and the role of innovative combined treatment paradigms.


OBJECTIVE
To highlight the salient psychological and interpersonal issues contributing to sexual health and dysfunction; to offer a four-tiered paradigm for understanding the evolution and maintenance of sexual symptoms; and to offer recommendations for clinical management and research.


METHODS
An International Consultation assembled over 200 multidisciplinary experts from 60 countries into 17 committees. The recommendations of committee members represent state-of-the-art knowledge and opinions of experts from five continents were developed in a process over a 2-year period. Concerning the Psychological and Interpersonal Committee of Sexual Function and Dysfunction, there were nine experts from five countries.


METHODS
Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation, and debate.


RESULTS
Medical and psychological therapies for sexual dysfunctions should address the intricate biopsychosocial influences of the patient, the partner, and the couple. The biopsychosocial model provides a compelling reason for skepticism that any single intervention (i.e., a phosphodiesterase type 5 inhibitor, supraphysiological doses of a hormone, processing of childhood victimization, marital therapy, pharmacotherapy of depression, etc.) will be sufficient for most patients or couples experiencing sexual dysfunction.


CONCLUSIONS
There is need for collaboration between healthcare practitioners from different disciplines in evaluation, treatment, and education issues surrounding sexual dysfunction. In many cases, neither psychotherapy alone nor medical intervention alone is sufficient for the lasting resolution of sexual problems. Assessment of male, female, and couples' sexual dysfunction should ideally include inquiry about: predisposing, precipitating, maintaining, and contextual factors. Treatment of lifelong and/or chronic dysfunction will be different from acquired or recent dysfunction. Research is needed to identify efficacious combined and/or integrated treatments for sexual dysfunction.
Althof
Stanley E
SE
Department of Urology, Case School of Medicine, Cleveland, OH, USA. sxa6@po.cwru.edu
Leiblum
Sandra R
SR
Chevret-Measson
Marie
M
Hartmann
Uwe
U
Levine
Stephen B
SB
McCabe
Marita
M
Plaut
Michael
M
Rodrigues
Oswaldo
O
Wylie
Kevan
K
D001007:Anxiety; D005260:Female; D006801:Humans; D007398:Interpersonal Relations; D008297:Male; D011613:Psychotherapy; D012735:Sexual Dysfunction, Physiological / Q000523:psychology* / Q000628:therapy; D020018:Sexual Dysfunctions, Psychological / Q000523:psychology* / Q000628:therapy