Abstract
Most successful treatments for sexual dysfunction are psychophysiological, in that physiological change circularly interacts with a psychological change. The topic of this article is female sexual dysfunction treatments that are psychologic, defined as interventions whose primary vector of action is initiated through psychological mechanisms in contrast to physiologic treatments initiated through a physical act on the body. In the enthusiasm for new physiologic approaches, there has been a strong tendency to overlook or dismiss the evidence that does exist for efficacious or promising psychologic treatments. Each diagnostic category of desire, arousal, orgasm, and pain disorders is briefly reviewed with respect to efficacious or effective criteria. The review shows there to be limited controlled research, with only orgasmic disorders meeting the more stringent “well established” criteria, promising but uncontrolled results for vaginismus and dyspareunia, minimal effectiveness data for hypoactive sexual desire disorder, and no available efficacy data on female sexual arousal disorder and sexual aversion. It is concluded that (a) since a psychologic treatment can and does impact sexual physiology, we need to continue to develop and test psychologic approaches both out of intellectual interest and out of respect for the choices patients require or prefer, (b) the prescription of a physiologic treatment which ignores the fact that human sexuality is infused with individual meaning may invite further interference with sexual functioning, and (c) future research would do well to test the efficacy of the psychologic and physiologic treatments, both separately and in combination, for female sexual dysfunction.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
REFERENCES
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th Ed.). Washington, DC: Author.
American Psychological Association. (1995). Training in and dissemination of empirically-validated psychological treatments: Report and recommendations. The Clinical Psychologist, 48, 3–24.
Andersen, B. L. (1983). Primary orgasmic dysfunction: Diagnostic considerations and review of treatment. Psychological Bulletin, 93, 105–136.
Barlow, D. H. (1986). Causes of sexual dysfunction: The role of anociety and cognitive interference. Journal of Consuiting and Clinical Psychology, 54, 140–148.
Basson, R. (2001). Human sex-response cycles. Journal of Sexual and Marital Therapy, 27, 33–43.
Basson, R., Berman, J., Burnett, A., Derogatis, L., Ferguson, D., Fourcroy, J., et al. (2000). Report of the International Consensus Development Conference on Female Sexual Dysfunction: Definitons and classifications. Journal of Urology, 163, 888–893.
Basson, R., McInnes, R., Smith, M. D., Hodgson, L., Spain, T., & Koppiker, N. (2000). Efficacy and safety of sildenafil in estrogenizedwomen with sexual dysfunction associated with female sexual arousal disorder [Abstract]. Obstetrics and Gynecology, 95 (Suppl. 4), 554.
Bartlik, B., Kaplan, P., Kaminetsky, J., Roentsch, G., & Goldberg, J. (1999). Medications with the potential to enhance sexual responsivity in women. Psychiatric Annals, 29, 46–53.
Bartlik, B., Legere, R., & Andersson, L. (1999). The combined use of sex therapy and testosterone replacement therapy for women. Psychiatric Annals, 29, 27–33.
Baxter, L. R., Schwartz, J. M., Bergman, K. S., Szuba, M. P., Guze, B. H., Mazziotta, J. C., et al. (1992). Caudate glucose metabolic rate changes with both drug and behavior therapy for obsessive-compulsive disorder. Archives of General Psychiatry, 49, 681–689.
Bergeron, S., Binik, Y. M., Khalife, S., & Pagidas, K. (1997). Vulvar vestibulitis syndrome: A critical review. Clinical Journal of Pain, 13, 27–42.
Bergeron, S., Binik, Y. M., Khalife, S., Pagidas, K., Glazer, H. I., Meana, M., & et al. (2001). A randomized comparison of group cognitive-behavioral therapy, surface electromyographic biofeedback, and vestibulectomy in the treatment of dyspareunia resulting from vulvar vestibulitis. Pain, 91, 297–306.
Borkovec, T. D., & Castonguay, L. G. (1998). What is the scientific meaning of empirically supported therapies? Journal of Consulting and Clinical Psychology, 66, 136–142.
Caruso, S., Intelisano, G., Lupo, L, & Agnello, C. (2001). Premenopausal women affected by sexual arousal disorder treated with sildenafil:A double-blind, cross-over, placebo controlled study. British Journal of Obstetrics and Gynecology, 108, 623–638.
Chambless, D. L., & Hollon, S. D. (1998), Defining empirically supported therapies. Journal of Consulting and Clinical Psychology, 66, 7–18.
Davis, S. R. (1998). The role of androgens and the menopause in the female sexual response. International Journal of Impotence Research. 10(Suppl. 2), 82–83.
Dobson, K. S., & Craig, K. D. (Eds.) (1998). Empirically supported therapies: Best practice in professional psychology. Thousand Oaks, CA: Sage.
Glazer, H. I., Rodke, G., Swencionis, C., Hertz, R., & Young, A. W. (1995). The treatment of vulvar vestibulitis syndrome. Journal of Reproductive Medicine, 40, 283–290.
Goetsch, M. F. (1991). Vulvar vestibulitis: Prevalence and historic features in a general gynecologic practice population. American Journal of Obstetrics and Gynecology, 164, 1609–1614.
Hawton, K., & Catalan, J. (1986). Prognostic factors in sex therapy. Behavior Research and Therapy, 24, 377–385.
Heiman, J. R. (1999). Female sexual dysfunction in menopausal women: Definitions and epidemiology. Menopause Review, 4, 11–15.
Heiman, J. R. (2000). Orgasmic disorders in women. In S.R. Leiblum, & R. C. Rosen (Eds.), Principles and practice of sex therapy (3rd ed.), pp. 118–153. New York: Guilford.
Heiman, J. R. (2001). Sexual desire in human relationships. In W. Everaerd, E. Laan, & S. Both (Eds.), Sexual appetite, desire and motivation: Energetics of the sexual system (pp. 117–134). Amsterdam: Royal Netherlands Academy.
Heiman, J. R., & Meston, C. M. (1997). Empirically validated treatment for sexual dysfunction. Annual Review of Sex Research, 8, 148–194.
Keller, M. B., McCullough, J. P., Klein, D. N., Arnow, B., Dunner, D. L., Gelenberg, A. J., et al. (2000). A comparison of nefazodone, the cognitive behavioral-analysis system of psychotherapy, and their combination for the treatment of chronic depression. New England Journal of Medicine, 342, 1462–1470.
Laumann, E. O., Paik, A., & Rosen, R. C. (1999). Sexual dysfunction in the United States: Prevalence and predictors. Journal of the American Medical Association, 281, 537–544.
Laumann, E. O., Gagnon, J. H., Michael, R. T., & Michaels, S. (1994). The social organization of sexuality: Sexual practices in the United States. Chicago: University of Chicago Press.
Leiblum, S. R. (2001). Critical overview of the new consensus-based Definitions and classifications of female sexual dysfunction. Journal of Sex and Marital Therapy, 27, 159–169.
Leiblum, S. R., & Rosen, R. C. (Eds.). (1988). Sexual desire disorders. New York: Guilford.
Masters, W., & Johnson, V. (1970). Human sexual inadequacy. Boston: Little, Brown.
Morokoff, P. J., & LoPiccolo, J. L. (1986). A comparative evaluation of minimal therapist contact and 15 session treatment for female orgasmic dysfunction. Journal of Consulting and Clinical Psychology, 54, 294–300.
Schreiner-Engel, P., & Schiavi, R. (1986). Lifetime psychopathology in individuals with low sexual desire. Journal of Nervous and Mental Disease, 174, 646–651.
Tiefer, L. (1995). Sex is not a natural act and other essays. Boulder, CO: Westview Press.
World Health Organization. (1992). ICD-10: International statistical classification of diseases and related health problems. Geneva: Author.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Heiman, J.R. Psychologic Treatments for Female Sexual Dysfunction: Are They Effective and Do We Need Them?. Arch Sex Behav 31, 445–450 (2002). https://doi.org/10.1023/A:1019848310142
Issue Date:
DOI: https://doi.org/10.1023/A:1019848310142