See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/263309812

Handbook of Sexual Dysfunction

Article in Archives of Sexual Behavior · December 2006

DOI: 10.1007/s10508-006-9101-z

CITATIONS READS
6 2,693

1 author:

Lori Brotto
University of British Columbia - Vancouver
273 PUBLICATIONS 7,865 CITATIONS

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Adolescent Sexual Problems View project

MVP Outcomes View project

All content following this page was uploaded by Lori Brotto on 20 August 2017.

The user has requested enhancement of the downloaded file.

Arch Sex Behav (2006) 35:761–764
DOI 10.1007/s10508-006-9101-z
B OOK REVIEW
Handbook of Sexual Dysfunction
Edited by Richard Balon and R. Taylor Segraves. Taylor & Francis, Boca Raton,
Florida, 2005, 339 pp., $150.00.
Reviewed by Lori A. Brotto
Published online: 31 October 2006

C Springer Science+Business Media, Inc. 2006
There have been several recent edited volumes on the topic
of sexual dysfunction and its treatment: Principles and Prac-
tice of Sex Therapy edited by Leiblum and Rosen (2000) for
$85; New Directions in Sex Therapy edited by Kleinplatz
(2001) for $45; Handbook of Clinical Sexuality for Mental
Health Professionals edited by Levine, Risen, and Althof
(2003) for $70; and Women’s Sexual Function and Dysfunc-
tion edited by Goldstein, Meston, Davis, and Traish (2005)
for $230. The present volume is a concise, highly practical
guide that is useful for the novice beginning in the field of
sexual dysfunction treatment as well as for the experienced
sexual health clinician who wants a comprehensive review
at their fingertips. Another overall strength of the chapters
are their biopsychosocial orientation which makes the book
suitable for both mental health (e.g., sex therapists, psy-
chologists, social workers) and medical (e.g., primary care
physicians, obstetrician gynecologists, urologists) providers.
The editors have assembled an excellent cadre of authors
who represent among the top clinician/researchers in the
area of sexual dysfunction. There are 12 chapters organized
according to the sexual dysfunction categories in the DSM-
IV-TR. In addition, there is one chapter devoted to the topic
of paraphilias.
At less than 350 pages in a 9 × 6 form, this volume is
highly portable and therefore likely to be referred to often.
At a price of $150, it may be considered costly for students;
however, the quality of the chapters makes the money well
worth it.
R. L. A. Brotto (
)
Department of Obstetrics and Gynaecology,
University of British Columbia,
805 West 12th Avenue, Room 119, Vancouver,
British Columbia V5Z 1M9, Canada
e-mail: lori.brotto@cvch.ca
The introductory chapter, entitled “Treatment of Sexual
Disorders in the 21st Century,” written by the editors pro-
vides a nice historical account of the evolution of current
treatment approaches. It provides an overview of the orig-
inal sex therapy approaches (largely psychoanalytic) in the
1960s, describes the rise of behavioral treatments in the
1970s, and introduces the trend towards more pharmaco-
logical interventions by urologists that began in the 1980s. It
briefly discusses the many epidemiological studies on sexual
dysfunction and includes references to even the most recently
published data by Laumann et al. (2005) on the largest cross-
cultural epidemiological study to date. The chapter also alerts
the reader to the more contentious areas of sexual dysfunc-
tion and its treatment, namely that of the dissatisfaction with
the medical model basis of the DSM-IV-TR (APA, 2000),
and the medicalization of sexuality more generally. Unfor-
tunately what is missing from this brief passage is reference
to the important work done by Tiefer and colleagues of the
New View Task Force (www.fsd-alert.org).
Chapter 2 is written by an American psychologist and
researcher, Perelman, and is entitled “Combination Therapy
for Sexual Dysfunction: Integrating Sex Therapy and Phar-
macotherapy.” In his articulate mode of writing, Perelman
provides a nice summary of the strengths of sex therapy and
expands on the brief history of treatments (both psychologi-
cal and medical) that was provided in Chapter 1. Then, focus-
ing on the phosphodiesterase type-5 (PDE-5) inhibitors that
were developed for erectile dysfunction, he provides some
often omitted data on discontinuation rates from medication
use, focusing both on organic as well as psychosocial barri-
ers. Perelman provides a concise algorithm for how medical
and mental health providers might work together with the
patient to determine the best treatment approach for that par-
ticular individual. The utility of his chapter lies in the fact
that it is a practical guide for both physicians and mental
Springer
762
health providers. Two case scenarios are presented that then
illustrate how the combination therapy approach is applied.
This is an overall excellent chapter with many useful tips
for the treating clinician/physician. Unfortunately, given that
there are no approved sexual pharmaceuticals for women,
the chapter, at present, is limited in its application to men
only.
Chapter 3 is entitled “Female Hypoactive Sexual Desire
Disorder” and was written by Basson, a leading Canadian
authority in the area of women’s sexual dysfunction. Basson
introduces the chapter by articulately describing the criti-
cisms of the HSDD criteria in the DSM-IV-TR. Drawing
from a large body of empirical and clinical evidence, Bas-
son refers to her own model of sexual response in women
which emphasizes motivations/incentives/reasons for initi-
ating or being receptive to sexual activity. Guidelines for
assessment of low desire and loss of sexual arousability are
then discussed and reflect a biopsychosocial approach, con-
sistent with the overall format of the book. Basson then
summarizes a vast literature on the biological aspects of de-
sire in women, discussing research in the areas of animal
models of low desire, brain imaging, and data on the effects
of androgens, estrogens, and sex hormone binding globu-
lin. She then discusses the “clinical dilemma” inherent to
testosterone measurement in women. Basson informs the
reader that the majority of testosterone is intracellular and is,
therefore, not measured in the standard assays–a finding that
has great clinical implications for physicians and therapists.
A brief review of the evidence-based psychological, non-
hormonal pharmacological (e.g., bupropion hydrochloride),
and hormonal treatments for low desire then follows. This
chapter is unique in its inclusion of a very useful list enti-
tled “recommendations for clinical practice,” which may be
used by the mental health provider or the physician. Unfor-
tunately, the chapter is missing a case illustration to show the
reader exactly how the model is applied to women with low
desire.
Chapter 4, entitled “Male Hypoactive Sexual Desire Dis-
order,” is written by a Canadian psychiatrist, Maurice. It is,
perhaps, the most comprehensive chapter of the book. More-
over, the editors should be applauded for including an entire
chapter devoted to low desire in men–a topic that does not
garner the attention that erectile dysfunction or premature
ejaculation do. There is a subsection of the chapter entitled
“Classification” in which Maurice uses cases to illustrate
subtle differences in diagnosing subtypes of HSDD in men.
The section on assessment provides quite specific questions
to probe as well as a “comment” that guides the clinician
in how to handle responses. This section should have been
placed in its own chapter and would have therefore not run the
risk of being “missed” by the reader. The section on etiology
is excellent and covers a vast literature on biological, social,
and psychological factors. It is organized well with a long
Springer
Arch Sex Behav (2006) 35:761–764
list of medical and psychiatric disorders that may contribute
to low desire in men separated into different paragraphs. The
section on treatment follows in the tradition of being quite
comprehensive, covering a large mass of literature on psy-
chotherapy and non-hormonal and hormonal drugs. This is
an excellent chapter that will be useful for the novice as well
as the seasoned clinician.
Chapter 5, entitled “Sexual Aversion Disorder,” by Janata
and Kingsberg is the shortest of the chapters (12 pages)
and is also a topic that is often neglected in textbooks of
sexual dysfunction. The strength of this chapter is in its
case description which is then followed by a discussion by
the authors in which classification issues and guidelines for
ruling out low desire and low arousal disorder are provided.
Despite the dearth of literature on this topic, the authors do
a nice job of describing three different treatment approaches
(cognitive-behavioral therapy, insight-oriented therapy, and
pharmacotherapy) but are unable to provide efficacy rates for
such treatments.
Chapter 6 is written by Laan, Everaerd, and Both and is
entitled “Female Sexual Arousal Disorder.” This particular
group of Dutch researchers has contributed significantly to
our understanding of women’s sexual arousal and are there-
fore ideally suited to submit this chapter. The authors begin
by providing a historical account of the research on women’s
sexual arousal. The section on etiology is excellent although
the authors did not include reference to the growing literature
supporting the role of hormones (androgens in particular) in
women’s sexual arousal. The authors then attempt to tackle
the contentious issue of accurately diagnosing FSAD accord-
ing to the DSM-IV-TR criteria and provide some interesting
insights into which impaired aspects of arousal might be the
most useful diagnostic indicators of a sexual dysfunction.
It is interesting that the authors advocate for the inclusion
of psychophysiological assessment of the genital arousal re-
sponse in making the diagnosis of FSAD given that this is
a research tool that is not used or available in most clinical
settings. Nonetheless, they provide a compelling argument
for the utility of this testing in clarifying the etiology of the
arousal complaints. Although perhaps of more relevance to
the researcher than the clinician, the authors discuss their the-
oretical view that sexual arousal is an emotional response that
generates a subjective feeling and they make the implication
that explicit memory is necessary in order for sexual feel-
ings to be experienced. The authors acknowledge that there
are currently no evidence-based psychological treatments for
FSAD and then proceed to provide a nice overview of the
comparably vast literature exploring promising pharmaco-
logical treatments. The chapter ends with recommendations
for clinical practice with, specifically, five questions that the
clinician should bear in mind when assessing the woman
with arousal complaints. Overall, this chapter provides an
excellent overview of the research in FSAD and how these
Arch Sex Behav (2006) 35:761–764
findings limit our diagnostic and treatment approaches; how-
ever, the first half of the chapter may be of more interest to
the researcher than the clinician. In addition, in keeping with
the format of the rest of the chapters, it would have been
illustrative to see a case example.
Chapter 7 on “Erectile Dysfunction” by Wylie and
MacInnes introduces a long list of medical, psychiatric, and
lifestyle variables that can contribute to ED. Unfortunately,
few references are provided and this section is not organized
in a way that could be helpful for the assessing clinician. They
then provide a very comprehensive but clear description of
the anatomy and physiology of erection–information that is
very helpful in determining if a diagnosis of ED is present.
The section on pathophysiology is helpful for guiding the
clinician to determine if there is a psychogenic and/or en-
docrinological or other organic basis to the ED. What would
have strengthened this section are some case illustrations.
Fourteen pages are devoted to pharmacological treatments
of ED and the authors do an excellent job of summarizing
this vast literature. However, only two pages are then devoted
to psychological approaches and the section is comparably
vague in terms of guiding the clinician.
Chapter 8, entitled “Female Orgasm Dysfunction,” is writ-
ten by Meston, a psychologist researcher, and Levin, a phys-
iologist. These authors tackle the interesting questions of
“What is an orgasm?” and “Why do women have orgasms”
and review a vast literature in doing so. Given that orgasmic
complaints in women are often related to the use of medi-
cations, the authors then review the research on the impact
of antidepressants, antipsychotics, nitric oxide, adrenergic
medications, and hormones. What is not addressed by the
authors in the section on assessing orgasmic complaints is
the role that inadequate stimulation (or, in other words, in-
sufficient arousal) plays in making a diagnosis. This has
been recognized by others to be an important consideration
in order to accurately diagnose Female Orgasmic Disorder
(Basson et al., 2003). Although the section on treatment of
FOD is very comprehensive and covers a vast literature on
efficacy studies, there is little guidance for the treating clini-
cian in how to conduct the treatment itself. Also missing from
the chapter are some case examples to guide the clinician.
Chapter 9, entitled “Male Ejaculation and Orgasmic Dis-
orders,” by Waldinger was admittedly somewhat of a disap-
pointment. Although the author has published widely on the
topic and provides informative and comprehensive informa-
tion on the neurophysiology and neurobiology of ejaculation,
drawing heavily from his research on rodents, the chapter is
lacking in information on psychological theories and ap-
proaches, and is deliberately biased against psychological
aspects of this condition. Instead, he strongly supports the
serotonin hypothesis in premature ejaculation given the suc-
cess of SSRIs in treating premature ejaculation. Waldinger
believes that claims of a psychological component to and
763
treatments for premature ejaculation are not based on evi-
dence and are, instead, “authority-based medicine” (p. 225).
He only briefly mentions well-known techniques, such as the
“stop start” and “squeeze” techniques, and does not cite any
literature on their efficacy. Moreover, the author claims that
psychological therapy is only indicated for those men who
have a difficult time coping with the diagnosis rather than
as a primary treatment–certainly a contentious claim. The
section on retarded (delayed) ejaculation is somewhat more
balanced; however, a thorough description of the psycho-
logical therapy approach is not given. No case illustrations
are given in the chapter thus making it limited in its util-
ity as a clinical guide. One positive aspect of the chapter is
the inclusion of topics on “anesthetic ejaculation,” “partial
ejaculatory incompetence,” “painful ejaculation,” and “pos-
torgasmic illness”–topics of interest that are rarely discussed
in most texts on sexual dysfunction.
Chapter 10 on “Dyspareunia” is written by the Canadian
research group at McGill University and is an overall ex-
ceptional chapter. Pukall et al. encourage the reader to con-
sider their multidimensional pain approach to the diagnosis
and treatment of dyspareunia and a notable strength of the
chapter, in this vein, is that the authors are a multidisci-
plinary group of psychologists and gynecologists who work
within a multidimensional pain approach. Case studies are
provided that illustrate very nicely the issues in assessment
and diagnosis, and the authors suggest specific questions to
ask the patient during the biopsychosocial history taking.
Their section on etiology is comprehensive and complete
and covers the range of organic as well as psychosocial
contributors. The segment on treatment is also complete and
balanced; however, it would have been helpful to have more
specific guidance on what cognitive behavioral treatment
looks like more than a brief statement of its components and
its efficacy. Although the authors acknowledge that relatively
little research is available on dyspareunia in men, it would
have been nice to see a brief overview on what is known
about this condition and what treatments are available.
Chapter 11, entitled “Vaginismus,” is written by Weijmar
Schultz and Van de Wiel, a multidisciplinary team of clin-
icians from the Netherlands. This represents, perhaps, the
most comprehensive yet concise chapter in the book in terms
of guiding the clinician to consider different etiological con-
tributors during assessment, and clearly detailing the steps
to be taken during treatment. The reader has a sense that he
or she would be able to formulate a treatment plan with a
vaginistic patient after reading this chapter. Although a case
illustration is not provided, the section on treatment steps is
sufficiently detailed that the case is not necessary.
The final chapter of the book, “Paraphilias,” by Osborne
and Wise was a curious addition to a textbook on “sexual
dysfunction” given that paraphilias do not fall under this
section of the DSM-IV-TR. Nonetheless, the chapter does
Springer
764
provide for the reader an informative overview of the nine
subtypes of paraphilia listed in the DSM-IV-TR focusing on
etiology, assessment, and treatment. Unfortunately, missing
from this chapter is an acknowledgement of the criticisms
of including paraphilias in the DSM (Moser, 2001) and case
illustrations.
Overall, this handbook deserves an “A” rating. For the
clinician treating sexual dysfunction who wants an easy
to transport, concise, comprehensive, and multidisciplinary
guide, this volume is a must-have and stands apart from many
of the other available textbooks on sexual dysfunction.
References
American Psychiatric Association. (2000). Diagnostic and statistical
manual of mental disorders (Fourth ed., text tev). Washington,
DC: Author.
Basson, R., Leiblum, S. L., Brotto, L. A., Derogatis, L., Fourcroy,
J., Fugl-Meyer, K., et al. (2003). Definitions of women’s sexual
Springer
Arch Sex Behav (2006) 35:761–764
dysfunctions reconsidered: Advocating expansion and revision.
Journal of Psychosomatic Obstetrics and Gynaecology, 24, 221–
229.
Goldstein, I., Meston, C. M., Davis, S., & Traish, A. (Eds.). (2005).
Women’s sexual function and dysfunction: Study, diagnosis, and
treatment. London: Taylor & Francis.
Kleinplatz, P. J. (Ed.). (2001). New directions in sex therapy: Innova-
tions and alternatives. New York: Brunner-Routledge.
Laumann, E. O., Nicolosi, A., Glasser, D. B., Paik, A., Gingell, C., et al.
(2005). Sexual problems among women and men aged 40–80 y:
prevalence and correlates identified in the Global Study of Sex-
ual Attitudes and Behaviors. International Journal of Impotence
Research, 17, 39–57.
Leiblum, S. R., & Rosen, R. C. (Eds.). (2000). Principles and practice
of sex therapy (3rd ed.). New York: Guilford Press.
Levine, S. B., Risen, C., & Althof, S. E. (Eds.). (2003). Handbook
of clinical sexuality for mental health professionals. New York:
Brunner Routledge.
Moser, C. (2001). Paraphilia: A critique of a confused concept.
In P. J. Kleinplatz, (Ed.), New directions in sex therapy: In-
novations and alternatives (pp. 91–108). New York: Brunner-
Routledge.
View publication stats