A Multidisciplinary Approach to the Treatment of Sexual Dysfunction in Couples
Authors: Lynn M , Iftekhar N , Mumby P , Hakimi M , Adam W 
Published: July 2022

ABSTRACT

Introduction
Sexual dysfunction (SD) affects at least a third of adult women worldwide which makes it a public health concern. Given the complexity of both psychological and biological pathology associated with these conditions, a multidisciplinary approach has been advocated. However, there is a limited amount of literature examining a multidisciplinary treatment approach to a couple's sexual and psychological functioning. This program, emphasizes treatment of the couple. This program includes a multidisciplinary team consisting of psychologists, gynecologists, urologists, dieticians, physical therapists, yoga instructors, and nurses. Our group collaborates in the care of each couple; working together to participate in the diagnosis and treatment of their sexual dysfunction. The treatment approach is a biopsychosocial model. Our couples attended weekly lectures on the follow topics: communication, female sexual functioning, male sexual functioning, stress management, chemistry of love, pelvic floor physical therapy, healthy diet, sexual aids, and gaining momentum. They also received counseling from a dyad therapist team. additionally, the couple was responsible for completing weekly homework consisting of sensate focus exercises and other gestures to help them engage with one another. In therapy sessions, communication and visualization exercises were also utilized.

Objective
This study prospectively followed couples pre- and post-attendance of a six-week sexual wellness treatment program (SWP) at a single academic medical center. The following outcomes were used: (1) sexual functioning (2) relationship satisfaction (3) mood stability.

Methods
The study was approved by the IRB. Couples attending the six-week multidisciplinary SWP, were consented and then completed surveys both pre-treatment and at the end of treatment. Surveys administered included the Dyadic Adjustment Scale (DAS), Sexual Functioning Profile (PROMIS), and International Index of Erectile Dysfunction (IIEF) for men only. Linear mixed-effects models were used to estimate the mean change from baseline to first follow-up. A covariance matrix was used to account for dependency. The program included weekly didactic sessions following an initial evaluation. Didactics included cognitive behavioral sex therapy with an attending (psychologist, psychiatrist or gynecologist) paired with a trainee (psychiatry, psychology or gynecology resident or a medical student), and home assignments.

Results
There were 85 respondents – 42 men, 43 women. Mean age was 49.82 years (Range 25-77). Most frequently reported SD were hypoactive sexual desire (32.2%), erectile dysfunction (21.4%), dyspareunia (14.3%), and female orgasmic disorder (10.7%). controlling for patients’ sex and baseline PHQ severity, all DAS measurements increased from baseline. The largest improvement was on the total DAS score which increased by approximately 5.18 (95% CI: 2.55 – 7.81) points. Similarly, the PROMIS global satisfaction with sex life score, erectile function score, and interest in sexual activity score significantly increased from baseline while the vaginal discomfort score significantly declined from baseline. Overall, the global satisfaction with sex life score increased from baseline by approximately 5.57 (95% CI: 3.03 – 8.10) points. Among male participants, the IIEF erectile, sexual, and satisfaction scores increased from baseline. On average, men reported a 4.33 (95% CI: 0.04 – 8.62) point increase in their IIEF erectile score from baseline.

Conclusions
The results indicate that a multidisciplinary treatment approach focused on the couple positively impacts multiple aspects of a couple's relationship, including global satisfaction with sex life, relationship satisfaction, interest in sexual activity, and erectile function. These findings emphasize that multidisciplinary sexual therapy programs aimed at the couple can help address multiple aspects of sexual well-being.

Disclosure
No