| 206 Room 520-A | Sexual Dysfunction Sunday, July 10, 2005 Time: 1:00 PM-4:00 PM |
A Biopsychosocial, Integrative Couple Approach to Assess, Treat, And Prevent Relapse of Male Sexual Dysfunction.
Metz, Michael *,1, McCarthy, Barry , 1 Meta Associates, St. Paul, Minnesota, USA
ABSTRACT- The traditional model of male sexual dysfunction (SD) emphasized that it was a simple problem usually treated with one approach (e.g., behavioral therapy, vacuum device, queeze technique, pharmacologic pill), and that there was no need for follow-up monitoring. This workshop summarizes the multidimensional, biopsychosocial approach to comprehensive sex therapy for male sexual problems developed by Metz & McCarthy as published in Coping with Premature Ejaculation (2003) and Coping with Erectile Dysfunction (2004). This approach conceptualizes sexual problems as multidimensional (physical, cognitive, behavioral, emotional, and interpersonal) issues, with multiple causes and multiple effects on the man and his intimate relationship. SD is best conceptualized, assessed, and treated using the model of the male being responsible for his sexuality and the couple working together as an ′:prime:]intimate team.:prime:]:prime:] The presentation reviews the Diagnostic Decision Tree process of exploring the nine types of SD four physical/medical (neurological system, physical illness, physical injury, pharmacologic side-effect), four psychological/relational (psychological system, psychological distress, psychosexual skills deficit, relationship, distress) and one mixed type (multiple sexual dysfunctions). The comprehensive treatment plan addresses all types and features for maximum outcome effectiveness. The emphasis is on understanding SD as multi-causal and multi–dimensional in terms of both causes and effects. Typically, the treatment plan involves a number of interventions tailored to the type(s) of SD and the physical, psychological, and relationship factors. There are medical, individual, and couple interventions. Addressing SD within the context of one′s relationship and socio-cultural situation includes cognitive and behavioral dimensions as well as the interpersonal features of relationship identity (expectations), conflict resolution and cooperation skills, and emotional empathy skills. Medical, physiological, and pharmacological techniques are not used as stand alone interventions, but are integrated into the comprehensive approach. Cognitive-behavioral interventions include a variety of techniques to develop couple communication for sexual comfort, relaxation training, monitoring and using the pelvic muscles, learning easy erections, arousal pacing, pleasure saturation, developing flexible sexual arousal scenarios, vaginal acclimatization, and relaxed and playful\intercourse. The couple learn to implement specific psychosexual skills for sexual desire, arousal, and satisfaction. The workshop will emphasize the importance of designing an individualized relapse prevention program, and discuss important clinical issues. Data does indicate high rates of non-compliance with pharmacologic therapies as well as traditional sex therapy relapse, so it is crucial to establish positive, realistic sexual expectations including how to cope with a lapse. Effective therapy utilizes all resources C medical, psychological, and relationship.
Key words: integrative sex therapy, biopsychosocial approach, couple/relationship intimacy, male sex dysfunction, sex dysfunction types