ROBB O. STANLEY and GRAHAM D. BURROWS
University of Melbourne, Australia
The treatment of male and female sexual dysfunctions is a multistage process with each stage important in determining the final success of therapy. Therapy proper starts with diagnosis and evaluation of the aetiology of the disorder, which is usually complex. The need for an effective evaluation of medical, psychiatric, psychological, social and cultural influences is an essential element of proper therapy. Subsequent stages of therapy may use a variety of strategies. The treatment of sexual dysfunction can take a psychodynamic psychotherapy approach, a brief focused eclectic psychotherapy approach, or a cognitive-behavioral approach, and hypnotic assistance to each of these is advantageous. The intention of this chapter is not to review these approaches extensively but rather to consider how hypnosis may be effectively added to them to improve efficacy.
Clinical difficulties in sexual functioning can arise at any phase of the normal sexual response and can come about from a wide variety of causes. The phases represented in normal sexual response are respectively: sexual interest; sexual arousal; sexual penetration; sexual orgasm, post-sexual resolution and post-sexual feelings. At each phase of the emotional and physical response, male sexual functioning may be hindered. Factors involved in the likely aetiology of the respective disorders are dealt with later.
A thorough evaluation of the nature of the disorder and its aetiology benefits from a multidisciplinary approach. With both male and female sexual dysfunction, medical evaluation is an absolute requirement before psychological treatment is commenced as interference with sexual functioning is an early symptom in a number of medical illnesses. General as well as specific genital, urological and neurological disease processes are investigated. Usage of illicit substances, legal recreational drugs and prescribed medication requires clarification. The role of psychiatric disorders and psychological difficulties in the presentation are deter-
International Handbook of Clinical Hypnosis. Edited by G. D. Burrows, R. O. Stanley and P. B. Bloom © 2001 John Wiley & Sons, Ltd mined, as are socio-psychological influences such as cultural expectations and qualities of relationship.
The Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-IV; APA, 1994) details the most commonly used diagnostic criteria for these disorders. Alternatively the World Health Organization's International Classification of Diseases (10th edition) (ICD-10; WHO 1992) allows for the classification of sexual dysfunction by a set of explicit criteria. To be classified as a sexual dysfunction it is essential that the difficulty causes distress to the individual concerned, or results in interpersonal difficulties. The disorder is not classified as a sexual dysfunction if it is the symptom of some other disorder classified elsewhere in the Axis 1 classifications of DSM-IV (e.g. depression or general anxiety).
All disorders are classified by type, that is the phase of the sexual response involved, and along three other dimensions: (a) whether lifelong or acquired; (b) whether generalized or situation specific; and (c) whether due to psychological; or combined psychological and medical causes; general medical condition-related; or substance use-related (prescribed or non-prescribed).
The lack of good epidemiological studies on normal sexual functioning, in particular contemporary studies, means that at all times the diagnosis of a sexual dysfunction relies upon clinical judgement. The presenting patients' culture, ethnicity, social and educational characteristics, age and gender features need to be taken into account in evaluating the appropriateness of the sexual response or behavior. Expectations and behaviors are greatly influenced by socio-cultural factors and it is essential the treating clinician does not impose his/her own expectations and standards onto the patient.
Where possible the clinician will benefit from a full evaluation of the context in which the sexual difficulties arise. The partner's account of the difficulties frequently adds new perspective on the nature and causes of these disorders.
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