Sexual dysfunction and relationships

Research studies have demonstrated that a central aspect of quality of life is the nature of both the objective and the subjective dimensions of intimate relationships. In fact, the literature reviewed earlier in this chapter demonstrated a negative association between intimate relationships and quality of life for men with sexual dysfunctions that centers on all phases of the sexual response cycle. In this section, we will review studies that have examined the association between relationship quality and sexual dysfunction more closely.

Although they did not specifically focus on the association between sexual dysfunction and relationship satisfaction, DiBartolo and Barlow found no relationship between marital satisfaction and the clinician’s ratings of psychogenic impairment among men with erectile disorder. Spouses’ marital satisfaction was also not related to these ratings. These findings are surprising, as other research would suggest that men with a strong psychogenic component to their sexual dysfunction would also experience high levels of marital distress; however, the results from the DiBartolo and Barlow study should be treated with caution, because the measure of marital distress was completed by the participants, and the rating of psychogenic contribution to the sexual dysfunction was completed by the clinician (on a 5-point rating scale). Further, the study sample was small, including only 32 men with erectile dysfunction and 18 spouses.

Korenman conducted a review of the literature that related to the association between erectile dysfunction and relationship quality and found that the evidence indicates that there is a relationship between this disorder and the quality of life of both the patient and his partner. As a result of the anger or anxiety associated with the disorder from either or both partners, the relationship frequently becomes impaired. Korenman emphasized the ripple effect of erectile dysfunction into other aspects of people’s lives and encouraged physicians to discuss feelings and reactions to sexual dysfunction with both patients and their partners to prevent this from occurring.

Korenman’s conclusions are drawn on a very limited numbers of studies that have explored the association between sexual dysfunction and relationship quality among men. Some of the treatment studies that are reviewed later in this chapter examine the impact of treatment on both sexual dysfunction and relationship functioning. Further studies, however, need to be conducted to obtain a better understanding of how this dimension of well-being relates to sexual dysfunction in men. It is also important to better understand how sexual dysfunction impacts the life quality of partners of men with sexual dysfunction. An understanding of these issues will provide information on the motivation of patients and their partners in seeking treatment for sexual problems and will thus better direct treatment programs on what dimensions should be addressed in therapy.

COMMON TREATMENTS FOR MALE SEXUAL DYSFUNCTION

The various treatment approaches for male sexual dysfunction are discussed in detail in Part IV of this volume. A brief summary of both the medical and the psychological approaches to treating male sexual dysfunction and the impact of different approaches on the quality of life of patients and their partners are provided.

Medication for the Treatment of Sexual Dysfunction

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Various pharmacologic approaches are currently in use for the treatment of male sexual dysfunction. The main medications have focused on problems in the arousal and orgasm phases of the sexual response cycle. Treatments for erectile disorder include penile implants, injection therapy, and oral medications. There are advantages and disadvantages of each of these interventions, with oral treatment being the least invasive approach.

There are a number of drugs that have been used in the treatment of premature ejaculation, including dopamine antagonists, antidepressants, benzodiazepine anxiolytics, and a number of other agents. Balon also noted the usefulness of antidepressant medication in cases for which psychological treatment was not effective, when the patient refused psychological intervention, or when partners were not willing to take part in treatment.

Disorders of sexual desire have been found to be the most resistant sexual dysfunction to treatment among both men and women. Outside of androgen treatment, few medical treatments have been developed to treat disorders in the desire phase. It would appear that medical treatments for sexual dysfunction in men have become more popular in recent years. This is partly due to the less intrusive nature of the newer oral medications and to the publicity associated with the medical treatment of sexual dysfunction in males, most particularly, the treatment of erectile dysfunction.

Psychological Treatments for Sexual Dysfunction

The most common psychological interventions for male sexual dysfunction are various types of cognitive behavioral therapies.

– For erectile disorders, these therapies focus on general arousal techniques and take the pressure off the need to achieve an erection.

– For premature ejaculation, they focus on slowing down the sexual interaction, so that the man is trained to tune into his arousal levels and control his ejaculatory response.

Hawton et al. found that cognitive behavioral treatment provided a relatively good long-term outcome for the treatment of erectile dysfunction but a poorer outcome for the treatment of premature ejaculation. McCabe found that cognitive behavioral therapy was effective for half of the respondents who experienced erectile dysfunction and for 75% of the respondents who experienced premature ejaculation. This type of therapy was not as effective for men with retarded ejaculation (only effective with 20% of participants), and no men with lack of sexual interest completed therapy.

The effectiveness of therapy appears to depend on a range of factors, other than the actual disorder. It would appear that the length of time the problem has been in place, the extent to which the man experiences multiple sexual problems, his attitudes toward therapy, whether or not his partner also has a sexual dysfunction, and the quality of his relationship with his partner all influence the success or otherwise of therapy.

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