Psychologic treatments for female sexual dysfunction: are they effective and do we need them?

Most successful treatments for sexual dysfunction are psychophysiological, in that physiological change circularly interacts with a psychological change. The topic of this article is female sexual dysfunction treatments that are psychologic, defined as interventions whose primary vector of action is initiated through psychological mechanisms in contrast to physiologic treatments initiated through a physical act on the body. In the enthusiasm for new physiologic approaches, there has been a strong tendency to overlook or dismiss the evidence that does exist for efficacious or promising psychologic treatments. Each diagnostic category of desire, arousal, orgasm, and pain disorders is briefly reviewed with respect to efficacious or effective criteria. The review shows there to be limited controlled research, with only orgasmic disorders meeting the more stringent "well established" criteria, promising but uncontrolled results for vaginismus and dyspareunia, minimal effectiveness data for hypoactive sexual desire disorder, and no available efficacy data on female sexual arousal disorder and sexual aversion. It is concluded that (a) since a psychologic treatment can and does impact sexual physiology, we need to continue to develop and test psychologic approaches both out of intellectual interest and out of respect for the choices patients require or prefer, (b) the prescription of a physiologic treatment which ignores the fact that human sexuality is infused with individual meaning may invite further interference with sexual functioning, and (c) future research would do well to test the efficacy of the psychologic and physiologic treatments, both separately and in combination, for female sexual dysfunction.