Couple therapy

Couples go through various stages through their time together, especially in long-term relationships. These stages typically are: marriage or establishment of stable sexual relationship, early parenthood (prenatal, having young children), late parenthood (adolescent children), midlife, older age, and then death. At each stage, relationship expectations may vary, and clinicians, when offering couple therapy, must take these stages into account.

Systemic therapy

(See E Systematic family and couple therapy in Chapter 2, pp. 34-42, and in Chapter 5, pp. 184-8.)

Such an approach looks at the whole system. If one partner develops symptoms, the other may adjust his/her life accordingly, so that, when the symptoms are treated, this may lead to resentment on the part of the partner who has already adjusted to the symptoms. Thus unwanted gains will need to be explored and dealt with in the course of the therapy.

Cognitive behavioural therapy

(See E Cognitive behavioural therapy in Chapter 2, pp. 30-4, and in Chapter 5, pp. 172-84.)

CBT is beginning to show some success rates. The focus in therapy is on challenging underlying assumptions which may be contributing to the sexual dysfunction. patients may be asked to keep diaries and include accompanying thoughts.

Psychoanalytic psychotherapies

(See E psychoanalytic psychotherapy in Chapter 2, pp. 30-4, and in Chapter 5, pp. 172-84.)

These have been used in some cases, but there are limited long-term data indicating improvement.

Physical treatments

(See E psychotherapy and medication in Chapter 7, pp. 322-4.)

Many conditions can be treated using physical treatments such as hormones. For erectile dysfunction, medications, such as sildenafil and tadalafil, or intra-cavernosal injections, such as papaverine, can be used. For other conditions, such as premature ejaculation, antidepressants have been shown to be effective, but these should be accompanied by supportive or exploratory psychotherapy to improve therapeutic adherence.


Sexual dysfunction is a very common psychiatric disorder and often gets ignored, either due to lack of expertise or lack of knowledge. Comorbidity with physical conditions and psychiatric conditions and iatrogenic onset must be remembered. Basic principles can be used to identify the degree of problems and potential solutions.

Recommended reading

Balon R and Segraves RT (eds) (2009). Clinical Manual of Sexual Disorders. American Psychiatric Publishing: Washington DC.

Bancroft J (2009). Human Sexuality and its Problems. Churchill Livingstone Elsevier: London and New York.

Bhugra D and Colombini G (2013). Sexual dysfunction: classification and assessment. Advances in Psychiatric Treatment, 19, 48-55.

Crowe M and Ridley J (2009). Couple Therapy. Blackwell: Oxford.

Leiblum S (ed) (2007). Principles and Practice of Sex Therapy. Guildford Press: New York.

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