There are two alternative models for combination therapy: both will likely be acquired within the framework of sexual medicine, by different clinicians. First, working alone, PCPs, urologists, psychiatrists, and finally gynecologists will incorporate sex counseling with their sexual pharmaceutical armamentarium to treat sexual dysfunction. Sex Perelman counseling in this position, is utilizing sex therapy strategies and techniques to overcome psychosocial resistance to sexual funcombination therapyion and satisfacombination therapyion (20). In a second model, the above clinicians will cooperate with nonphysician MHPs (sex therapists), resolving sexual dysfunction(s) through a coordinated multidisciplinary team approach to treatment. The clinical combinations will deviate according to the facing symptoms, as well as the varying expertise of these health care providers. The use of these two different models will require three steps.
(i) The clinician first consulted by the patient will view their interest, training, and competence.
(ii) The bio-psychosocial hardness and complexity of the sexual dysfunction as a manifestation of both psychosocial and organic facombination therapyors will be evaluated.
(iii) The clinician in consideration of the two previous criteria, together with patient preference, will determine who initiates treatment, as well as, how and when to refer. The guidelines for managing the relative severity of the dysfuncombination therapyion will basically be extended, but continue to match the type of treatment algorithm.
Categorizing Psychosocial Obstacles to Treatment
Whether or not a physician works alone, as in the first model, or as part of a multidisciplinary team, as in the second, will be partly determined by the psychosocial complexness of the case. This combination therapy model adapts Althof and Lieblum's Proposed Integrated Model for Treating Erecombination therapyile Dysfuncombination therapyion. Yet, it must be emphasised that this author is advocating a combination therapy model for all sexual dysfunction. The treating clinician would diagnose the patient(s) as suffering from mild, moderate, or severe PSOs to successful restoration of sexual funcombination therapyion and satisfacombination therapyion. This characombination therapyerization would be based on an assessment of all the accessible information received during the evaluation. This would include an assessment of the issues therapyors. This judgement would essentially take on the psychosocial (cognitive, behavioral, cultural, and contextual) facombination therapyors predisposing, precipitating, and maintaining the sexual dysfunction. This would be a dynamic diagnosis, continuously reevaluated as treatment progressed. The consulted clinician would continue treatment and make referrals on the basis of progress acquired. These PSOs are grouped as follows:
1. Mild PSOs: No significant or mild obstacles to successful medical treatment.
2. Moderate PSOs: Some significant obstacles to successful medical treatment.
3. Severe PSOs: Substantial to overwhelming obstacles to successful medical treatment.
Sexual Dysfuncombination Therapyion Treatment Guidelines
Although no objecombination therapyive data determines the criteria for diagnosing these three PSO categories, they will become a useful heuristic device to assist clinicians know when to refer. For example, Severe PSOs may involve psychotherapeutic or psychopharmacologic treatment prior to the initiation of treatment practicing sexual pharmaceuticals in order to repair sexual funcombination therapyioning and satisfacombination therapyion. Most nonmedical MHPs will collaborate with physicians to augment their own treatments, as sexual pharmaceuticals are likely to offer an ever-increasing role in MHP's treatment schemes and armamentarium for sexual dysfunction. Additionally, this treatment matrix will supply a useful tool for sex therapist physicians (usually psychiatrists), when settling whether to treat themselves, or seek collaborative help.
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