BIOPSYCHOSOCIAL APPROACH OF A MALE SEXUAL DYSFUNCTION CASE

Abstract

Biopsychosocial diagnoses, including medication mechanisms, are important for the treatment of sexual dysfunction. A 23-years-old man reported being very shy and demanding a lot of himself. He used to masturbate with anal stimulation and to have premature ejaculation (PE) even in masturbations. He only tried to have his first sexual intercourse nine months ago, when he had erectile dysfunction (ED). Since then, he had few attempts, always with ED and PE. He had varicocele and altered sperm test. His father is elderly and has difficulty walking. The diagnoses were ED, PE, social phobia, strong obsessive personality traits, depressive reaction, and arousal excitement for anal stimulation for which he felt guilty. Treatment included psychotherapy, Sertraline 25 mg, Diazepam and Sildenafil if necessary, as well as sexual exercise and urological evaluation. Varicolele surgery was suggested, but it did not justify sexual dysfunction. He was reluctant to start treatment and maintained ED and PE. When he used Sildenafil, had no ED but he did have PE. When Sertralina was started, he achieved ejaculatory delay. Sertraline treats social phobia and delays ejaculation due to the effect of serotonin, improving PE. It was used in a very low dose, because it inhibits libido. Diazepam also causes sexual dysfunction, so it has been avoided. Thus, with these medications associated with psychotherapy, he started having sex normally. Shortly thereafter, he suspended the drugs without impairing sexual function. Psychotherapy continued and the following aspects were worked on: the feeling of guilty in relation to fantasies of anal stimulation; low self-steem; fear of being criticized; fantasies about varicocele and loss of sperm mobility; excessive self-charging and the week internal father. As self-esteem and self-confidence improved, he began to have a healthy sex life.