(492) The Sexual Tipping Point®: Why We Should Employ A “Biomedical-psychosocial & Cultural Model Versus, The Current “Bio-psychosocial” One
Authors: Perelman M 
Published: May 2023

Abstract

Introduction
Healthcare professionals need to embrace the term “Biomedical-psychosocial & Cultural” to describe our model for understanding, diagnosing, and treating sexual disorders. The “Bio-psychosocial model,” widely accepted by mental health professionals, is progressively the predominant view of physicians generally. However, it is incomplete and represents an outdated over-reaction to the formerly exclusively held “Biomedical Model.” Additionally, the term “Cultural” should be added our model’s lexicon. Healthcare’s “biomedical” view of disease was upended with the publication of Engel’s (1977) “biopsychosocial model”, which emphasized multiple etiological determinants. Evidence gradually accumulated that a combined pharmacologic and psychotherapeutic approaches were the most effective treatment for most conditions. Urologists were late to this realization, in part because of sildenafil’s successful launch (1998), which catalyzed urology’s ascendancy over other specialties (psychiatry, psychology, and gynecology) which traditionally managed sexual issues. The educational efforts of sexual medicine societies (ISSM, SMSNA, ISSWSH, etc.) in the early 21st century helped rebalance appreciation for multidisciplinary expertise and multidimensional understanding. Subsequently, most sexual medicine specialists have adopted a “bio-psychosocial model,” recognizing that sexual disorders always have a psychosocial component even when organicity is significant. But it is time to change terminology again, to incorporate “biomedical” and “cultural” to capture a better understanding of sexual disorder etiology and treatment. Why? The last 25 years have seen many significant advances in our capacity to identify biological causes/correlates (imaging, etc.) of sexual disorders. Additionally, pharmaceutical marketing success has generated the greatest levels of drug consumption in history, including drugs to improve sexual functioning. But there is an ever-increasing list of disease-treating drugs with anti-sexual side effects, which often cause/contribute to sexual disorders. Changing medication, dosing patterns or timing sometimes helps overcome negative side effects. Pro-sexual drugs (e.g., PDE5s) sometimes reverse side-effects. But iatrogenic factors’ role in sexual disorder(s) etiology is still not fully appreciated. Incorporating the term “Biomedical” back into our model’s lexicon will help enhance recognition of that reality. The need to incorporate the term “culture” within our sexuality models, is best exemplified by current discussions surrounding gender and the continuing controversy as to what constitutes “normal.” The various “identity movements,” advancements and their messaged tenants of the late 20th and early 21st century (amplified by social media), have resulted in raised international consciousness of additional psychosocial and cultural factors which should at least be considered when diagnosing and/or treating sexual disorders. The Sexual Tipping Point Model’s® (STP) dynamic framework provides for continuous and evolving evaluation which recognizes cultural context, while allowing for better formulation of needed clinical intervention(s) whether biomedical and/or psychosocial.

Objective
Advocating healthcare professionals adopt a “biomedical-psychosocial and cultural” model to better understand, diagnose and treat sexual disorders.

Methods
Literature review.

Results
“Bio-psychosocial” models may result in the risk of under-emphasizing biomedical and cultural factors’ role in sexual disorder etiology and treatment.

Conclusions
Healthcare professional nomenclature should employ “Biomedical-psychosocial & Cultural,” used by the STP as the phrase that best describes our model for understanding sexual response and for diagnosing and treating its disorders. The public could then be educated accordingly.

Disclosure
Any of the authors act as a consultant, employee or shareholder of an industry for: Merck, Palatin, Pfizer, Sprout.