Most Difficult to Treat: Sexual Desire Disorders

Reviews the book, Treating sexual desire disorders: A clinical casebook edited by Sandra R. Leiblum (see record 2010-13144-000). This book contains fourteen chapters covering diagnosis and treatment of sexual desire disorders. Whereas the chapter authors differ in their approaches to desire problems, all the chapters agree on two important issues. First, there is wide agreement that disorders of desire—as opposed to problems in sexual functioning such as arousal, erection, or orgasmic dysfunctions—are now the most commonly seen sexual problems in clinical practice. The second issue—and the reason for this book—is that although very effective treatment programs have been developed for both arousal and orgasmic dysfunctions, treatment of desire problems is more complex and less effective. The book begins with an excellent overview by Leiblum in which she makes a number of important points that are generally also mentioned by the chapter authors. It is noted that there are no objective standards for what is a low level of desire—too many interpersonal, cultural, and historical factors affect sexuality to make setting an arbitrary frequency count a sensible idea. Another important theme stressed is that there is not really such an entity as low desire in the sense of a uniform cause or clinical presentation. Rather, low desire is perhaps best thought of as an indication that something else is seriously disrupted in the patient’s history, relationship, sexual functioning, or other causative mechanism. Perhaps the most valuable contribution of several of the chapters of this book is presentation of information on how to deal with the effects of low desire on the couples’ relationships. Overall, Treating Sexual Desire Disorders is a valuable addition to the clinical literature on treatment of sexual dysfunction. Successful treatment of low-drive cases requires knowledge of treatment methods for sexual problems, and also for relationship problems. As is noted in some of these chapters, focusing on just the relationship issues often repairs the damage done by the low drive but doesn’t raise the low drive. In a similar manner, attempting to work only on the low drive has been found not to be very successful and often just leads to the couple ending therapy very quickly. This book offers an integrated approach: Both issues must be addressed. It is also stressed that therapy must be individualized—custom tailored to match the etiology and life situation of each case.