(356) Reframing The Bio-psychosocial Model. For Sexual Medicine
Authors: Perelman M 
Published: February 2024

Abstract

Introduction
Most sexual medicine and sex therapy clinicians consider the biopsychosocial model the current gold standard for the diagnosis and treatment of sexual disorders. While paying lip service to that, both groups tend to focus on a couple aspects of the model overly exclusively, with insufficient awareness/attention to other contributing factors. Professionals tend to “stay in their lane,” but this can result in poorer patient care. Explicitly expanding the biopsychosocial model’s scope can help clinicians address “blind spots,” which can result in overlooking key etiological factors. Healthcare’s “medical model” perspective was upended with the publication of Engel’s (1977) “biopsychosocial model,” which emphasized multiple etiological determinants. The last decades since Engel have seen significant advances in our capacity to identify disorder’s biological causes through biomedical advances (imaging, etc.). Pharmaceutical marketing success has generated the greatest drug consumption in history, including drugs to improve sexual functioning. More people are living longer than ever with chronic disease and surviving cancer. Unfortunately, many of the ‘cures” result in iatrogenic sexual disorders because of their anti-sexual side effects. Explicitly recognizing that the prefix “bio’ represents both biological and biomedical will help enhance the re-recognition of the full range of organic factors in the diagnosis and successful treatment of sexual disorders. Doing so will lead to a greater appreciation of biomedical advances and improved recognition of iatrogenic causation for sex therapists and sexual medicine experts alike. Many sexual medicine specialists recognize psychosocial factors such as depression, anxiety, self-esteem, and satisfaction. But clinicians must also focus on specific cognitive and behavioral mechanisms and patterns (sexual scripts) that contribute to developing and maintaining sexual disorders. The need to explicitly incorporate “culture” within our sexuality model is best exemplified by current discussions surrounding gender and the continuing controversy about what constitutes “normal.” The various “identity movements’,” messaged tenants of the late 20th and early 21st century (amplified by social media), have raised international consciousness of additional psychosocial and cultural factors that should at least be considered when diagnosing and/or treating sexual disorders. There is a need for clinician sensitivity (especially in today’s world), which is enhanced by recognizing that despite culture’s complex, far-reaching constellation of factors, they must be incorporated when considering psychosocial factors.

Objective
Sexuality professionals need to recognize and accept an expanded view of the biopsychosocial model's scope.

Methods
Literature review.

Results
Limitations in how the biopsychosocial model is currently used may risk under-emphasizing the role of organic, behavioral, and cultural factors in sexual disorder etiology and treatment.

Conclusions
“Biopsychosocial” should be seen as an explicit “stand-in” for all predisposing, precipitating, and maintaining bio-medical/surgical, cognitive, behavioral, emotional, social, and cultural factors determining the etiology and treatment of sexual disorders. Such an explicit expansion of the model will provide multidimensional clarity and understanding that will help the next generation of clinicians adopt a transdisciplinary perspective, not merely a multidisciplinary one.

Disclosure
No.