CausesDrugs:Sex Education for Adultspsychotropicdrugs,especiallyantidepressantsandneuroleptics,mayaffect sexualRESEARCHERSMASTERS ANDJOHNSONfunction and so many of thedrugs used in general medicinesuchasantihypertensives anddiuretics.The mostcommonculprits areSSRls,whichfrequentlyreducelibidoand/orproduceanorgasmiain both sexesMastersWH,JohnsonVETimemagazine,May25,1970
Causes Drugs: psychotropic drugs, especially antidepressants and neuroleptics, may affect sexual function and so many of the drugs used in general medicine, such as antihypertensives and diuretics. The most common culprits are SSRIs, which frequently reduce libido and/or produce anorgasmia in both sexes. Masters WH, Johnson VE Time magazine, May 25, 1970
AssessmentIfbothpartnersattend,theyshould,iftheyagree,beinterviewedseparatelyandthentogetherThetwopartiesfrequentlydifferintheirviewofwhattheproblemisandintheirdesirefortreatment,and itisimportanttobe clearaboutsuchdifferences.Thedurationoftheproblem,andwhetheritispresentwithotherpartners and in masturbation, should be established.Amedicalhistory,psychiatrichistory,andphysicalexaminationshouldalwaysbeobtained,followedbylaboratoryinvestigationsifindicated.Itisespeciallyimportanttousea sensitive,non-judgementalstylewheninterviewingpeoplewithsexualproblems
Assessment If both partners attend, they should, if they agree, be interviewed separately and then together. The two parties frequently differ in their view of what the problem is, and in their desire for treatment, and it is important to be clear about such differences. The duration of the problem, and whether it is present with other partners and in masturbation, should be established. A medical history, psychiatric history, and physical examination should always be obtained, followed by laboratory investigations if indicated. It is especially important to use a sensitive, non-judgemental style when interviewing people with sexual problems
TreatmentUnderlyingcauses,suchaspsychiatricormedical illness,shouldbemanagedappropriately.Psychological approaches:simpleexplanation andcounselling may be all that is reguired, andsometimescanbebestprovidedfromthemanyuseful books andvideos available tothe public.More complex cases mayneedformal psychotherapy,individually orasa couple
Treatment Underlying causes, such as psychiatric or medical illness, should be managed appropriately. • Psychological approaches: simple explanation and counselling may be all that is required, and sometimes can be best provided from the many useful books and videos available to the public. More complex cases may need formal psychotherapy, individually or as a couple
TreatmentSextherapy:thisderivesfromthemethodsofSomeof the commonMastersandJohnson.Thecoupleareusuallycauses of sexualtreatedtogether.Treatmentbeginswithadysfunction are:‘sensatefocus'phaseduringwhichintercourseis not attempted,so that the?unskilled or uncaringcouplestoprepeating anexperienceoffailurepartnerbut spend aset timealonetogethereachdaycommunicationproblemsto concentrateontalkingaboutrelationshipanxiety,depressionorfearissues and exchanging non-genitalphysica?a gynecologic diseaseaffection.?deep-seated psychologicalproblemsInstages,thecouplethenworktowardprior history of sexualgenital stimulation,followed byintercourse.abuseTheymaybetaughtspecifictechniquesaccording tothetypeofdysfunctionpresent;forexample,thesqueezetechnigueforpremature ejaculation,or extendedforeplayinWADAMorgasmicdelay
Treatment Sex therapy: this derives from the methods of Masters and Johnson. The couple are usually treated together. Treatment begins with a ‘sensate focus’ phase during which intercourse is not attempted, so that the couple stop repeating an experience of failure, but spend a set time alone together each day to concentrate on talking about relationship issues and exchanging non-genital physical affection. In stages, the couple then work toward genital stimulation, followed by intercourse. They may be taught specific techniques according to the type of dysfunction present; for example, the ‘squeeze technique’ for premature ejaculation, or extended foreplay in orgasmic delay
TreatmentSystemicdrugs:theseareappropriatewhenaspecificmedicalindicationispresentExamplesinclude:-oestrogen/progesteronehormonereplacementtherapyinpostmenopausalwomen-thephosphodiesterasetype-5inhibitorssildenafilViagra)tadalafil,andvardenafil increasecyclicguanosinemonophosphate(cGMP)leadingtopenile smoothmusclerelaxation
Treatment Systemic drugs: these are appropriate when a specific medical indication is present. Examples include: – oestrogen/progesterone hormone replacement therapy in postmenopausal women – the phosphodiesterase type-5 inhibitors sildenafil (Viagra), tadalafil, and vardenafil increase cyclic guanosine monophosphate (cGMP), leading to penile smooth muscle relaxation