Impact of treatment on quality of life of men: part 2

Relationship Quality

A couple’s relationship is often tied in with the development and maintenance of a sexual dysfunction. The partner may also be experiencing a sexual dysfunction and may thus be reluctant for the man’s problem to be resolved. For example, if the partner of a man with premature ejaculation is experiencing inhibited sexual desire, she may be reluctant for him to be treated for this condition, since she would not want the sexual interaction to be extended. Sexual dysfunction may also create an emotional distance in the relationship, so that neither partner needs to confront their feelings of anger or confront the fact that they are not in love with their partner. Sexual dysfunctions can also be used to control a relationship or to exert power over the partner. For example, a woman may exhibit inhibited sexual desire and withhold an interest in sex so that she has power in at least some aspect of her relationship with her partner. Given the number of ways that sexual dysfunction can impact a relationship, it is easy to see why a partner may be reluctant to participate in treatment, or may actively sabotage the treatment process. In order for treatment to be successful, there needs to be willingness between both partners to develop a renewed sense of emotional involvement, with the associated risks that this entails.

The quality of the relationship, as well as the needs of his sexual partner, should be addressed in the treatment of sexually dysfunctional men. It has been shown that sexual and relationship problems are linked, and that effective therapy for men leads to an improvement in their relationship.

There have been few studies that have examined the effect of treatment on relationship issues. Since relationship problems have been shown to be related to the onset and maintenance of sexual problems in men, it would be expected that remediation of the sexual problem would also lead to an improvement in relationship functioning.

Medical treatments of male sexual problems, which are targeted specifically on the sexual disorder, are not designed to address relationship issues. There may be an improvement in relationship functioning as the sexual problem is resolved, or the difficulties encountered in the relationship may persist. Longterm evaluation of these interventions, with a consideration of broader individual and social functioning, will identify the extent to which these interventions lead to an improvement in individual quality of life and relationship functioning.

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Many psychological treatments are designed to intervene at the relationship level, as well as target individual factors related to the development and maintenance of the sexual problem. There has been inadequate evaluation, however, of the effectiveness of these treatments and the impact of improvement in sexual functioning on the overall functioning of the individual. Since these programs frequently focus on sexual and verbal communication between the partners, as well as resolution of individual and relationship issues, it would be expected that, for successful interventions, there would be an improvement in the relationship quality, and in both partners’ satisfaction with their relationship.

Impact of treatment on quality of life of men: part 1

The effectiveness of most forms of interventions for male sexual dysfunction has not been subject to adequate evaluation. The evaluations that have been conducted frequently concentrate only on the remediation of the sexual problem and fail to examine the overall quality of life of participants. Due to the large range of factors responsible for the onset of sexual dysfunction and the fact that sexual dysfunction impacts a number of life areas, one would expect that treatment would also impact areas outside of sexual functioning. The following discussion reviews the literature available regarding the impact of treatment on both the individual quality of life of men with sexual dysfunction and the impact of treatment on their relationships.

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Treatment is most likely to be effective with men who experience sexual problems in the arousal or orgasm phases of the sexual response cycle. McCabe found that a large percentage of men who completed a cognitive behavioral program for sexual dysfunction still experienced problems at the end of therapy. In fact, 35.5% of males still experienced sexual dysfunction 75% to 100% of the time at the end of therapy. This was a substantial shift, however, from the levels of sexual dysfunction pretherapy, in which 100% of the men experienced sexual dysfunction 75% to 100% of the time. The results of this study suggested that men seek help for their sexual problems only when they are well entrenched, more likely to impact other aspects of their lives, and more resistant to change.

McCabe examined the outcomes of therapy for men with low sexual desire. Successful therapy was found to be associated with a broadening of the men’s sexual repertoire, a development of more positive attitudes to sex, the men perceiving themselves positively as a sexual person, a development of an emotional self, and experiencing sex within an emotional relationship. Given the substantial nature of these changes, it is clear why many attempts to treat inhibited sexual desire are unsuccessful. Although the outcomes of therapy lead to significant changes in the man’s attitudes toward himself, his sexuality, and his capacity to experience emotions, these changes are so fundamental to the man’s core personality, they are not readily amenable to change.

Although changes after therapy lead to significant improvements in the quality of life of men that go well beyond the sexual arena, it requires highly motivated patients to achieve these gains. Successful therapy is associated with a change in attitude to sex, a greater enjoyment in sexual activities, and more positive feelings about one’s own sexuality. The extent to which more broad-ranging changes occur in the individual quality of life of men after therapy requires further investigation.