Sex Therapy or Sexual Medicine – Why not both?

I must say that I find it difficult when psychotherapists (a category in which I include myself) are so dismissive of drugs to aid in solving complex sexual problems.

Why do we assume a binary trade-off between “the mind” and “the body?”

It should be clear to all of us that both work in tandem, one responding to the other. When you are stressed, your cortisol levels rise. When men stay home taking care of their children their testosterone drops. When a woman has hormonal surges prior to menstruation she may get “crazy-seeming.”  I think we do a major disservice to our clients when we focus on just one area and ignore the other.

Why are we so resistant to the idea that hormones and chemicals are part of the equation in the sexual response of adults? 

When we see two teenagers in line for a movie and they can’t take their hands off each other, we don’t assume “they must have just had a meaningful conversation” or “he must have just brought her flowers,” we assume that their hormones are raging. Why are we so resistant to that perspective when we’re talking about adults?

While over-use of medication can be a problem, underuse is as well.

We’ve seen dozens of men whose anxiety is relieved with PDE-5 inhibitors like Viagra or Cialis. Medications can often do in a short period, what may take psychotherapy a long time to achieve. The subconscious is very powerful and when anxiety is relieved, often the use of the medication is fairly temporary!

I know many psychotherapists are suspicious of drug companies. Thank G-d for big pharma and capitalism. If it wasn’t for the money, drug companies would never bother with looking for drugs that may help female desire. I, for one, need every tool in the tool kit. The two newest FDA approved drugs for women, Addyi and Vyleesi, when used appropriately and in conjunction with other treatments, will be effective on a modest group of women. Yahoo! I’ll take that until something better comes along. The side effects are fairly minimal and within a few months women will be able to see if the drug is working for them and if it isn’t, they will stop. Women are not idiots.

Also, while we’re condemning the drug companies for having their eye on the profits, if we are honest,  money is to be made on both sides of the equation. The therapists are also making money on women with sexual problems. And although I’m sure it is not conscious, if a client is paying a therapist $150 a session (and that’s modest; Here in NY sex therapists are charging upwards of $250/hour) they’d be making $5000 a year on that client. It’s hard to suggest that they too, don’t have a financial interest in keeping the status quo.  

Here’s my bottom line take-away: to solve many sexual issues the best approach, by far, is a combination of the medical and the psychological.

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