Eficacia de la terapia de pareja con pacientes con cáncer: una revisión sistemática

Objetivo: Conocer la eficacia o utilidad de la terapia de pareja en casos donde uno de los miembros de la pareja padece cáncer. Así como conocer en qué casos o en qué momentos puede ser más útil este tipo de terapia. Método: Se realizó una búsqueda sistemática en las bases de datos electrónicas: Scopus, Pubmed y PsycInfo, utilizándose palabras clave, tales como: Couple sex therapy, Cancer, Breast cancer, Prostate cancer, Couple psychological therapy, Intimacy, Clinical trial y Efficacy; y sus múltiples combinaciones. Se han incluido artículos en inglés de entre los años 2007 y 2019. Resultados: Los 11 estudios seleccionados únicamente trataban de cáncer de mama y próstata y la mayoría de ellos se lleva a cabo con una media relativamente pequeña. La mayoría de los tratamientos se aplica desde la corriente cognitivo-conductual y existen mejores resultados si el tratamiento está manualizado. En los casos de cáncer de próstata se trata con más normalidad aspectos relacionados con la sexualidad que en casos de cáncer de mama. Se observan mayores mejoras en cáncer de próstata ya que tienen que ver con aspectos sexuales además de psicológicos (pese a que con tiempo se pierdan dichas mejoras). Conclusiones: Se aprecia eficacia inicial en lo que a satisfacción de la relación y problemas sexuales en la pareja se refiere, pero estos resultados no se mantienen a lo largo del tiempo. Por lo que en general hablaríamos de una eficacia real baja.

Sexual Dysfunction and Couple Dysfunction

Couple sex therapy is best understood as a subspecialty of couple therapy. Couple sex therapy may focus on problems in desire, pleasure, eroticism, and/or satisfaction. Although arousal and orgasm problems need to be carefully assessed and treated, problems related to desire represent the primary concern that brings couples to sex therapy. There is a great need for more research on sex therapy models, therapeutic processes, and outcome. The authors describe in detail the psychobiosocial model of assessment, treatment, and relapse prevention. A particularly important component is the four-session assessment, which features individual psychological, relational, and sexual histories. This comprehensive, multidimensional treatment model focuses on the use of psychosexual skill exercises practiced at home by the couple. Therapy interventions are directed at factors that subvert sexual desire and function as well as interventions to promote desire, pleasure, eroticism, and satisfaction. Clients are urged to develop a couple sexual style that balances each person’s sexual voice, thus becoming an intimate sexual team. The goal for all couples, straight or gay, married or unmarried, is to integrate intimacy and eroticism into their relationship. An individualized relapse prevention plan is also discussed as an integral component of comprehensive couple sex therapy.

Supra-Biological Factors in the Assessment of Males Seeking Penile Prostheses

The technique of installing penile prostheses for treatment of erectile dysfunction in the male is becoming increasingly popular, particularly, but by no means exclusively in the cases of impotence in which biological factors are clearly implicated. The literature to date fails to take into account suprabiological factors such as the nature of the couple's sexual relationship and more particularly the sexual myths that shape their sexual behaviour. The author evaluated eight couples in which the male was seeking a penile prostheses and in all eight couples a variety of sexual myths had contributed to major sexual problems for the couple, even before the onset of the erectile dysfunction. A plea is made for discarding the false dichotomy or “organic” versus “functional”, in favour of a list of etiological factors including the biological ones as well as suprabiological ones. Also, the installation of penile implants should only be considered after a full investigation of the couple's sexuality by a competent sex therapist and only when other forms of couple/sex therapy have failed.