Professor Sparks Debate On Treatment Of Sexual Dysfunction

Over the past decade, a little blue pill has transformed how sexual disorders are perceived by doctors, sex therapists and the public at large. But while a Valparaiso University psychologist and leading sex disorder researcher says looking at sexual dysfunction as a medical problem has helped some people seeking help, too often the behavioral and social factors underlying individuals' sexual problems are being ignored.

An article by psychology professor Dr. David Rowland in the newest edition of the Journal of Sex and Marital Therapy outlines the negative impacts of an increasing reliance on medication to solve sexual disorders and calls for more comprehensive assessment of those disorders.

Dr. Rowland's article "Will Medical Solutions to Sexual Problems Make Sexological Care and Science Obsolete?" is the lead article in the journal, with the rest of the issue 16 commentaries by international experts in sexual medicine responding to it.

"It became apparent once Viagra was released that a rapid shift would happen from looking at a combination of psychological, social and biological factors in understanding sexual dysfunction to an almost exclusive focus on medical factors," he said. "As more pharmacological treatments become available, men and women will increasingly turn to them for solutions to their sexual problems. Some of this shift is appropriate and beneficial in serving the needs of patients. However, concern arises when such shifts are likely to limit the meaningful choices presented to the patient and dampen support for basic psychotherapy research in sexology."

Giving short shrift to the effect of a rocky marital relationship, for example, and simply relying on a prescription drug can result in a poor outcome for the patient.

"The patient and his or her partner are less likely to understand the value and, in some instances, the need to address psychological and relationship elements of the problem," Dr. Rowland said. "A patient may find that fixing the sexual response does little to fix the larger problem of regaining a satisfying sexual life with their partner."

For many men, he said the treatment of sexual dysfunctions such as premature ejaculation may well be most effective when prescriptions are combined with psychotherapy. Yet few studies have attempted to explore the most effective methods to combine medication and psychotherapy.

"Pharmaceuticals are a treatment, not a cure, for sexual dysfunction," Dr. Rowland said. "Yet because these treatments have had success, it has inhibited basic research regarding psychological factors by shifting away economic resources."

Dr. Rowland said researchers simply do not know how effective contemporary psychotherapeutic procedures might be in the treatment of dysfunctions such as premature ejaculation, since most published data are more than 20 years old and represent different techniques than therapies used today.

While pharmaceuticals like Viagra are often call 'wonder drugs,' Dr. Rowland said the medical community and drug companies would be wise to tell patients that pills may not be enough to address the problem.

In fact, Dr. Rowland said, pharmaceutical companies would likely benefit from acknowledging their drugs aren't a cure-all for sexual dysfunction and supporting research on the efficacy of psychotherapy on premature ejaculation and other dysfunctions.

"Pharmaceutical companies have a vested interest in understanding the key components of psychotherapy that might improve positive long-term outcomes for patients," Dr. Rowland said. "Pharmaceutical research efforts also will carry marketing cachet when they are perceived as broad endeavors that benefit not just the pharmaceutical company but society as a whole."