Antidepressants, antianxiety, and antipanic medications are being used with psychotherapy in treating desire-phase problems and in treating paraphilic compulsive-obsessive behaviors (Coleman 1991). Recent anecdotal reports and some early controlled studies are finding a category of antidepressant medications useful in treating sexual disorders. SSRIs, such as Zoleft, Paxix, and Prozac, are useful in increasing the latency time for ejaculation, and thus are helping some men who present with problems of ejaculatory control (early ejaculation). Another medication, Anafranil, and antidepressants used in treating obsessive-compulsive disorders, have been demonstrated in at least one study to help in the treatment of premature ejaculation. Of course, these results occur when therapy is provided, for if medication is discontinued, there can be a resumption of symptoms. That suggests the presence of untreated anxiety, relationship problems, or a constitutional tendency towards difficulty with ejaculation control.
An unfortunate side effect of SSRIs is the frequent complaint by patients of some loss of sexual desire. This has been reported by patients on these medications for depression. In some patients, however, the lifting of their depression symptoms alone is enough to increase their libido, despite the use of medication. Wellbrutrin, a relatively recent antidepressant, is claimed to have few negative effects on sexual desire. A newly marketed antidepressant, Serzone, is also being hailed for having no negative effects on libido.
Vulvodynia, a Newly Identified Syndrome
One of the new challenges facing American sex therapists and gynecologists today is the occurrence in many women of a painful burning sensation in the vulvar and vaginal area. This condition, recently named vulvodynia, or burning vulva syndrome, is a form of vestibulitis that can have a number of causes, from microorganisms that cause dermatosis to inflammation of the vestibular glands. The presenting complaint of these women is burning and painful intercourse. Some women develop secondary vaginismus. Discomfort varies from constant pain to localized spots highly sensitive to touch. In many cases, the psychological and relationship consequences are grave. Many women become depressed as a result and frustrated by attempts at treatment.
Current treatment includes topical preparations, laser surgery to ablate affected areas, dietary restrictions, and referral to a physical therapist to realign pelvic structure and reduce pressure on the spinal nerves serving the genital area. Some affected women have sought relief with acupuncture. Therapy may be enhanced by focusing on the effects of the condition on the sexual functioning of the patient, her relationship with her partner, and self-image. Pain-reduction techniques, including self-hypnosis, have proven valuable in some cases. Low doses of an antidepressant, including some SSRIs, may reduce the pain.
There is much work to be done in the treatment of vulvodynia, including making the public aware of this condition and educating physicians in the role that sex therapists can play in supporting these women and their partners.
The Medicalization of Sex Therapy
There is an increasing medicalization in sex therapy today. Although this may at first seem to benefit many patients – and it does – there is a concern among sex therapists that many conditions will be summarily treated through medications by primary physicians, with a corresponding failure to address the dynamic and interpersonal aspects of the patient. In short, there is a danger of incomplete evaluation of the patient’s status if only the medical aspects are considered and the therapist is left out of the process. In the ideal situation, the sex therapist and physician would collaborate on the treatment plan, using medication as indicated.