epublishing store: Intro

Sexual Health eBook Volume4
Chapter 6

Therapy Update for Women. The Treatment of Low Libido in Women Using an Integrated Biopsychosocial Approach, Marianne Brandon and Andrew T. Goldstein

Sexual health is a necessary aspect of general health for many adults. Women report feeling more satisfied with various aspects of life when they are comfortable with their sexual functioning (Oberg & Fugl-Meyer, 2005). Several common sexual concerns can leave women feeling sexually dissatisfied, sexually unhealthy, or somehow sexually inadequate, often prompting them to seek help. These issues are addressed in chapters by Ellison, Duplaisse & Daniluk, Graziottin, and Ogden in this book series and can include concerns about orgasm, libido, and sexual pain. In this chapter, we will focus on the treatment of low libido in women.

For men and women alike, libido represents a primary aspect of sexual health. In fact, low libido is the most frequently reported sexual concern among women. A commonly cited study suggests that over a third of women experience decreased libido at some time in their lives (Laumann, Paik, & Rosen, 1999). Patients struggling with low sex drive often report significant emotional discomfort within themselves and in their relationships as a result of their sexual disinterest (Bancroft, Loftus, & Long, 2003; Laumann et al., 1999).

ommon concerns expressed by women who report prolonged low sex drive include loss of pleasure in feeling feminine, discomfort with their bodies, loss of physical and emotional intimacy with their partners, fear of their partner’s infidelity, and even fear of divorce. Women with low libido describe intercourse as unsatisfying, uncomfortable, or even intrusive. They frequently explain that the daily rigors of life take their toll, and that expending even more energy to have sex is often nearly impossible. In addition, they report feelings of guilt and shame about not wanting what they perceive to be a healthy part of life and relationships. How do clinicians best assist such patients in creating fulfilling, rewarding, and gratifying sexual moments for a woman and her partner?

Most practitioners working in the area of women’s health are regularly faced with this question. Basson (2006) has summarized the various factors that should be taken into consideration when diagnosing and treating women with desire and arousal disorders. Women of all ages, ethnic backgrounds, and education levels report concerns about low desire. Regardless of whether a woman is actually diagnosed with hypoactive sexual desire disorder (HSDD), if she seeks help for the subjective experience of a decreased libido, practitioners must embrace a theoretical framework for her care. In this chapter, we explore a holistic, integrative, biopsychosocial model for such treatment.

This biopsychosocial treatment model to which we subscribe was the natural outgrowth of our professional collaboration in meeting the needs of our patients. Dr. Goldstein, a board certified gynecologist with a specialized focus in female sexual dysfunction, and Dr. Brandon, a clinical psychologist and diplomat in sex therapy, founded the Sexual Wellness Center in Annapolis, Maryland, after determining that individual private practice care was not addressing women’s sexual concerns as effectively as collaborative treatment. In joining forces, treatment for both of us became more productive, efficient, and enjoyable. The treatment benefits to our clients were immediately apparent, as were the advantages to us of a more interesting and satisfying work environment. Like us, many other clinicians have formed similar teams in order to provide optimal treatment options for their clients.

In this chapter we will outline first why we believe the traditional treatment model involving a sole practitioner providing the majority of patient care does not optimally serve patients with low libido. Second, we will review some of the benefits for both patients and clinicians of practicing within a biopsychosocial treatment paradigm. Third, we will describe our particular framework for treating low libido in women. This integrated biopsychosocial treatment model addresses four quadrants of a woman’s experience; namely, her physical, emotional, intellectual, and spiritual health, as they relate to her libido. Within each quadrant, issues within her romantic relationship are also explored. The impact of environmental and cultural influences are also considered within each quadrant. This results in an assessment and treatment model that takes into account the full complexity of a woman in the context of her world.

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