Integrating medical and psychological treatment for sexual problems: the psyche and the soma

Abstract

I approach the integration of medical and psychological treatment for sexual problems from the perspective of a medical graduate for 41 years, and as a specialist obstetrician, gynaecologist and sexologist I learned that medical practitioners do not have all the answers, but neither do psychologists or all the other ‘-ologists’, but that together we can get so many of the answers. The emergence of Psychosomatic Obstetrics & Gynaecology suited my developing thirst for knowledge in this area to try and make me more effective in managing among other things patients' psychosexual difficulties. Combining this with learning about the actual therapeutic process, what doctoring actually does and how in many instances we can be effective just with the counselling process, not prescribing a ‘silver bullet’ or using the scalpel along the way, as in the Balint model of being a medical instrument. Abnormal illness behaviour, its offshoot – pain behaviour and abnormal treatment behaviour, concepts still not covered in medical schools, will be discussed. A case will be made for using the biopsychological model rather than the traditional medical illness model in the management of sexual dysfunctions.

Keywords:

• abnormal illness behaviour
• abnormal treatment behaviour
• pain behaviour
• somatisation
• vaginismus
• iatrogenic sexual dysfunction
• biopsychological model