The "New View" Approach to Men's Sexual Problems

Introduction

The preeminent model of men's sexual problems that has developed over the past 30 years (especially after the 1992 National Institutes of Health (NIH) Consensus Conference on Impotence^[1,2]) emphasizes organic causes of erectile and other sexual function problems and has paved the way for the legendary success of sildenafil (Viagra, Pfizer) and subsequent sexuopharmaceuticals. Numerous continuing education courses have adopted this perspective and emphasized sexual pathophysiology and the value of sexuopharmaceuticals in ameliorating men's sexual problems.

Over the same period, however, evidence has emerged to challenge the salience of this model. The challenges come from a methodologically diverse array of medical and social science studies that emphasize the central role of psychological, relational, and cultural factors in men's sexual expectations and satisfactions and downplay the importance of a universal model of sexual function and satisfaction. The challenges also come from critics concerned about the pharmaceutical industry's overweening role in the medicalization of sexual problems through its influence on sex research, guidelines development, professional education, journal publication practices, and possible "disease-mongering."^[3-7] Clinicians interested in a more independent and inclusive approach to understanding, assessing, and treating men's sexual problems can turn to one first developed in 2000 for women by a group of clinicians, sex therapists, and social scientists, called "The New View." A review of this approach is available as a Medscape continuing education course on women's sexual problems.^[8]

This course will present the "New View" approach to sexual problems of men and has the following objectives:

1. To familiarize clinicians with some of the research and theory prioritizing cultural, relational, and individual sources of men's sexual problems
   
   
2. To introduce the New View paradigm as it applies to men's sexual problems
   
   
3. To provide office resources to help clinicians address men's sexual problems
   
   
4. To present case studies of men's sexual problems that can be addressed using the New View paradigm.

This CME/CE Clinical Update is thus organized around 7 major themes:

1. Men's sexual problems in the context of masculinity norms
   
   
2. A brief overview of the management of men's sexual problems prior to 1998
   
   
3. Research and guidelines on men's sexual problems following the introduction of sexuopharmaceuticals
   
   
4. Medical and social science research emphasizing the importance of psychological, relational, and cultural factors in the understanding and management of men's sexual problems
   
   
5. The New View approach and classification system
   
   
6. Office resources: a sexual history questionnaire, bibliography, simple counseling technique using the P-LI-SS-IT model, and guidelines for making referrals
   
   
7. Case studies