My preferred approach to treating individuals and couples who are experiencing difficulties with one or all of the stages of the sexual response cycle (desire, arousal, orgasm) is the biopsychosocial model. Why? Any of these three, the biological, the psychological, and the social aspect of individual’s life can positively or negatively affect her/his sexual desire and intimate relationships.
First, it is important to address any medical conditions. The progression of a chronic disease over time can reduce an individual’s ability to experience desire, arousal, and orgasm. There are several types of medications used to treat medical conditions that are known to have adverse sexual side effects. Collaboration with an individual's primary care provider in addressing these issues is part of a multidisciplinary approach to treatment.
Second, conducting an assessment of an individual's psychological well being is an essential part of treatment. A person who is depressed may experience a lack of pleasure or motivation in normally pleasurable activities. This lack of pleasure directly influences an individual’s ability to experience desire, arousal or orgasm. In addition, some medications used to treat depression are known to have sexual side effects. Issues of body image, low self-esteem, and performance anxiety contribute to increased depression and anxiety thus further complicating an individual's ability to be intimate with their partner or spouse.
Last, socially or an individual’s interpersonal relationships and environmental/external stressors must be considered. An individual or a couple experiencing financial problems may find it difficult to experience desire or pleasure with her/his partner or spouse. Anxiety and constant worries about finances may consume the individual or couple and assign the sexual aspect of their relationship a low priority. Underlying anger or disappointment in one’s partner or spouse may leave that individual unable to experience desire for sexual intimacy and she/he may in fact be avoiding it!
The ability to COMMUNICATE effectively usually deteriorates when there are problems in the biopsychosocial functioning of an individual. If an individual or couple loses the ability to communicate, the relationship suffers---greatly. All this being said, I believe it is also important to identify and use an individual or couple’s STRENGTHS as part of the focus of treatment. Yes, even when someone can’t easily identify her/his strengths, we all possess strengths that can be utilized in improving the quality of life, relationships, and our sexuality.