ABSTRACT
In this chapter we are taken into the workings of a busy clinic in rural Iran, a place where men (and occasionally women) come for help with sexual problems. The urgency for successful treatment to gain or restore sexual function is illustrated by the fact that marriages, reputations, and even lives hang in the balance. According to the authors, sex therapy, even were it available, is not a viable option in this part of the world where the need for immediate resolution of sexual dysfunction is intense. They advocate for a strictly sexual medicine approach to the treatment of sexual dysfunction. Somewhat controversially, they use intracavernosal injections for the treatment of unconsummated marriage without knowing whether there is a female dysfunction, specifi cally dyspareunia or vaginismus that might account for the problem. The authors observe that life for women in Iran will be dismal if they cannot have sex within their marriage. Such women are likely to be divorced, leaving them penniless and unmarriageable. Because of the cultural imperative, the discussion in this chapter centers on the importance of accomplishing penetrative sex. Pleasure and intimacy are absent from the discussion of treatment, especially for women. It will be important for the reader to decide whether this is a helpful treatment approach or not, but the issues raised in this chapter are certainly thought-provoking.
