Abnormal Psychology

510 CHAPTER 11

that might bear on the current diffi culties. This information helps the sex therapist

determine what specifi c psychological factors contribute to the patient’s sexual dys-

function. For example, Lola in Case 11.11 was concerned about losing control dur-

ing orgasm, and the man in Case 11.12 was afraid that he’d be “under a woman’s

dominion” if he had orgasm during vaginal intercourse.

Assessing Social Factors

A sex therapist investigates how relationship issues affect a patient’s sexuality and

whether the sexual diffi culties occur only with the patient’s partner or more gener-

ally. For instance, the therapist might ask what function sex serves in the relation-

ship and how unresolved confl ict and power issues affect the sexual aspect of the

relationship (Stock & Moser, 2001). Other questions might address how the couple

decides on the timing, duration, or specifi c activities of sexual relations. Depending

on the answers, the sex therapist may target specifi c social factors as part of the

treatment.

Treating Sexual Dysfunctions

Once the specifi c nature of the sexual problem has been determined, treatment can

target the relevant factors. Depending on the nature of the problem and the types

of treatments the patient—and his or her partner—are interested in, treatment may

include medication, cognitive-behavioral therapy, sex therapy (which may provide

specifi c guidance and techniques to treat sexual problems), couples therapy, or some

other type of therapy.

Targeting Neurological and Other Biological Factors:

Medications

There has been an increasing trend toward the medicalization of sex therapy, that

is, a tendency to target neurological and other biological factors (see Table 11.8)

and pay less attention to other factors. In the 1990s, medical treatments for erectile

dysfunction began in earnest with the advent of the drug Viagra and the market-

ing campaign for it, which brought the topic of erectile dysfunction from a rarely

discussed but relatively common problem among older men to a topic of everyday

conversation. Viagra (sildenafi l citrate) is one of the class of drugs called phospho-

diesterase type 5 inhibitors, or PDE-5 inhibitors. Viagra doesn’t cause an erection

directly; instead, the drug operates by increasing the fl ow of blood to the penis only

when a man is sexually excited. Viagra (and its competitors, such as Cialis) is not

a cure but a treatment for impotence, and it is effective only if the man takes a pill

before sexual activity.

Sexual phase Female Male

Desire Hypoactive sexual desire disorder: Testosterone pills or cream; Wellbutrin

(bupropion) may counteract diminished desire that is a side effect of SSRIs

taken for another disorder

Sexual aversion disorder: Antianxiety medication for the phobia or panic

component

Arousal Female sexual arousal disorder:

PDE-5 inhibitors when arousal

problems have a medical cause

Erectile disorder:

PDE-5 inhibitors

Orgasm Premature ejaculation: SSRIs

Pain Vaginismus: Antianxiety medication

Dyspareunia: Estrogen cream

Table 11.8 • Medications for Sexual Dysfunctions