East Asian Arch Psychiatry 2012;22:170
BOOK REVIEW
As a layman, we may be aware that ‘impotence’ — more politically correct to be called ‘sexual dysfunction’ — is a common source of distress among the male population. There is a saying among the old Hongkongers that receding hairline and impotence are the 2 ultimate nightmares for men over their forties. As a medical professional, however, we do not hear such complaints in the consultation room as frequently as expected.
In Hong Kong society, one’s sex life is still a taboo subject, and is seldom brought up for serious discussion. Specialised care for patients presenting with sexual problems is also exceedingly rare. So in our everyday psychiatric practice, apart from writing referral letters, are there any ways that we can help our patients who present with sexual problems?
This petite, 108-page manual of Sexual Dysfunction in Men (Advances in Psychotherapy — Evidence-based Practice) by Dr David L. Rowland might serve as a good introductory read about this aspect.
The manual is divided into 6 chapters, namely (1) Description; (2) Theories and Models of Sexual Dysfunction; (3) Diagnosis and Treatment Indications; (4) Treatment — Low Sexual Desire, Erectile Dysfunction, Premature Ejaculation, Delayed and Inhibited Ejaculation; (5) Final Thoughts and Notes; and finally, (6) Case Vignette.
Throughout the book, the author repeatedly highlights the fact that treatment for sexual dysfunction should always entail a multi-dimensional approach, considering the biological, psychological, relationship-based, and socio- cultural factors for each patient independently. Apart from theory, the author also provides a detailed step-by- step guide on how to tackle the 4 main sexual complaints of male patients (low sexual desire; erectile dysfunction; premature ejaculation; delayed and inhibited ejaculation) in the Treatment section, from definition, important points in history taking, investigation to treatment. The treatment for each specific complaint is clearly laid out, from pharmacological to psychological ones, and backed up by references on evidence-based strategies.
What I remember most about this book is the succinct 2-page chapter on Final Thoughts and Notes. The author summarises from his experience, and in the process advises therapists to adhere to 11 cardinal principles. Examples of such advice deal with the need to: (i) be open and supportive when he communicates about an individual’s sexual problems; (ii) broaden the scope of ‘sexual experiences’ beyond the genital response; (iii) involve partners in the treatment and explore any relationship issues; and (iv) look out for underlying medical problems manifesting as sexual dysfunction.
After reading this book, readers can obtain a convenient overview on the management of male sexual problems, which will probably suffice in everyday psychiatric practice. However, most of the research and data cited in the book were mainly based on white / Hispanic / black populations. As suggested by the author, one must consider ethnic and cultural factors in the management of an individual’s sexual problems. Nonetheless, when it comes to sexual problems, the book successfully sheds light on the importance of holistic management as opposed to simply prescribing pills for ‘better sex’.
Debby Hiu-Ha Lam (email: lamdebby@gmail.com) Department of Psychiatry
Pamela Youde Nethersole Eastern Hospital
Hong Kong SAR, China
