ABSTRACT
Evolution of Current Treatment Approaches 2
Epidemiology of Sexual Dysfunction 4
Nomenclature 5
Evolving Models 6
Medicalization of Sexuality 8
Conclusion 8
References 9
In the last decades of the 20th century, major changes have occurred in our under-
standing, conceptualization, and treatment of sexual problems. Much of this
change was heralded in by the development of oral therapies for the treatment
of erectile disorders, the off-label usage of serotonergic antidepressants to treat
rapid ejaculation, the increasingly common use of unapproved use of androgens
to increase libido in women with hypoactive sexual desire disorder, and the com-
bined use of anti-androgens and serotonergic antidepressants to treat paraphilias.
The wide spread usage of effective biological therapies for sexual disorders has
contributed to the increasing emphasis on biological models concerning etiology,
often to the neglect of psychological factors. In the 1960s, it was commonly
assumed that most sexual problems were psychogenic in etiology (1).
However, the advent of effective biological therapies has shifted the focus to
organic causes of erectile dysfunction (2). These changes in assumed etiology
have had profound effects on treatment and conceptualization of the origins of
sexual disorders. Many patients who used to be treated by behavioral therapy
are now being treated pharmacologically. The rapid development of biological
models of therapy has brought valuable help to many individuals who previously
had minimal treatment choices. However, a number of factors including the large
number of men who dont refill sildenafil prescriptions indicate that pharma-
cotherapy alone may not always be sufficient (3). To date, there is insufficient
data to indicate when pharmacotherapy alone, psychotherapy alone, or combined
therapy is indicated for most of the sexual disorders.
