Treatment of Sexual Disorders - Evolution of Current Treatment Approaches

In the 1960s, psychiatrical handling of sexual issues was preponderantly psychoanalytic psychotherapy. In the mid- to late-1960s, behavioural therapists started issuing clinical series documenting the successful treatment of sexual problems by the use of classical qualifying techniques. Indeed, the 2 Segraves and Balon start stop technique for the treatment of quick ejaculation was first named by Semans in 1956. Nevertheless, the major apply of behavioral techniques to handle sexual problems began after the publishing of Human Sexual Inadequacy by Masters and Johnson in 1970. In the 1980s, subject compositions began appearing in the psychiatrical literature about utilizing monoamine oxidase inhibitors and low dose antipsychotic drugs to address quick ejaculation. Yet, the use of psychiatrical drugs to address quick ejaculation became much more common after the introduction of the selective serotonin reuptake inhibitors.

Urologists have made great contributions to the treatment of erectile dysfunction. Both the Small-Carrion and inflatable penile prostheses were introduced in the 1970s. Although patents for vacuum erection devices were obtained as early as 1917, the introduction of the vacuum erection pump by Osborn in 1974 resulted in this being a common resolution for many men before the introduction of other treatment options. Alprostadil intracorporal injections were presented in the 1980s. However, the popularity of treatment approaches minimized dramatically with the introduction of sildenafil in 1998 and the later introduction of tadalafil and vardenafil. Nowadays a man could take an effective oral agent that provided sexual behavior to happen in a more natural way. Understandably, as the essential etiology of erectile dysfunction for majority of aging men is vascular, the main focusing of therapeutic directed research of erectile dysfunction has been the vascular dysfunction/insufficiency area. The previously touted use of androgenic hormones in erectile dysfunction has been deserted as it became clear that androgen administration does not better erectile dysfunction in eugonadal men. Interestingly, testosterone substitute in men with age-related mild hypogonadism is not effective in reversing symptoms of hypogonadism (in contrast to the same situation in older men).

The successful introduction of sildenafil contributed to the research forpharmacological treatments for female sexual disorders. Initially, many companiesdid clinical trials in women with substances that had established prosperous in treatingerection problems. Generally, these trials were unsuccessful. The one exception isa clitoral vacuum erection device, which has FDA approval. Another approach is the study of androgens to induce want in women. Off-label use of androgen preparations increased significantly after the work by Gelfand andSherwin demonstrated that supraphysiological levels of testosterone enhanced libido in postmenopausal women. The apply of androgen preparationsto handle desire problems in women is currently undergoing clinical trials. As Rosen pointed out, many large pharmaceutical trials of female sexual dysfunction areunfortunately impeded by various methodological issues, such as the deficiency of apply of physiological outcome measures and the lack of consensus classification system for female sexual dysfunction in determining inclusion and exclusion criteria.There is also no precise and stable definition of normal sexuality available. Definition is also of dubious clinical usefulness.

The lack of success in search for efficacious pharmaceutics for treatment of sexual dysfunction in women directed to the examination and use of variousTreatment of Sexual Disorders botanical or herbal, and other contents in these indications; for review see Ref. As Rowland and Tai caution us, the effects of herbals tend tobe limited, relatively nonspecific, poorly studied, and associated with unpredictableor unfamiliar side effects.

The recent focus on pharmacological and other biological handling of sexual dysfunction regrettably takes away attention and emphasis from psychological treatments. However, as Heiman points out, psychological treatments are efficacious (though their presented efficacy is frequently limited) and needed (for various reasons, such as optimisation of psychological treatments, patient choice, low frequency of side effects, etc.). Heiman alsocautions that the prescription of a physiologic treatment that disregards the fact that human sexuality is instilled with individual meaning may invite further interference with sexual functioning.

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