Sex coaching for physicians: combination treatment for patient and partner

Physicians dealing with sexual dysfunction (SD) must consider the psychological and behavioral aspects of their patient's diagnosis and management, as well as organic causes and risk factors. Integrating sex therapy and other psychological techniques into their office practice will improve effectiveness in treating SD. This presentation provides information about the psychological forces of patient and partner resistance, which impact patient compliance and sex lives beyond organic illness and mere performance anxiety. Four key areas are reviewed: (1) ‘Sex coaching for physicians’ uses the ‘Cornell Model’ for conceptualizing and treating SD. A 5-min ‘sex status,’ manages ‘time crunch’ by rapidly identifying common causes of sexual dysfunction (insufficient stimulation, depression, etc). (2) Augmenting pharmacotherapy with sex therapy when treating erectile dysfunction (ED) specifically, or SD generally is stressed. Sex therapy is useful as a monotherapy or an adjunctive treatment and is often the ‘combination therapy’ of choice when treating SD. The following therapeutic integrations are highlighted: modifying patient's initial expectations; sexual pharmaceuticals use as a therapeutic probe; ‘follow-up’ to manage noncompliance and improve outcome; relapse prevention. (3) Issues specific to the role of the partner of the ED patient are described. The physician must appreciate the role of couple's issues in causing and/or exacerbating the ED and the impact of the ED on the patient/partner relationship. Successful treatment requires a supportive available sexual partner, yet partner cooperation may be independent of partner attendance during the office visit. Preliminary data from a survey of SMSNA members practice patterns, regarding partner issues, is presented and discussed. The importance of evoking partner support and cooperation independent of actual attendance during office visits is emphasized. (4) Finally, the need for more patient and partner educational materials to assist the physician in overcoming a patient/partner's emotional barriers to sexual success in a time efficient manner are discussed.