Use the PLISSIT Model for Patients With Low Libido

To best serve midlife patients who are having some form of sexual dysfunction, OB/GYNs must develop skills that allow for discussions with patients about their sexual concerns, said Sheryl A. Kingsberg, PhD, at the 25th Annual Meeting of The North American Menopause Society held last week in Washington, DC. Participating in the first plenary symposium on low libido at midlife, Kingsberg, who is professor of reproductive biology and psychiatry at Case Western Reserve University School of Medicine, Cleveland, Ohio, recommended that OB/GYNs utilize the PLISSIT Model, which she says is easy to use for office-based counseling of sexual problems.

But first, educate women about what's normal in the female sexual response cycle. For example, Masters and Johnson cite excitement, plateau, orgasm, and resolution and, similarly, Singer Kaplan cites desire (sex is often in the brain), arousal, and orgasm. (Kingsberg also suggested that you can ask your patients whether they've seen the Showtime series Masters of Sex, which chronicles the lives and research of William Masters and Virginia Johnson.)

The PLISSIT Model works using the following principles:

- Permission to be sexual and to talk about it, reassure women that they aren't alone, and empathize with their problems and concerns.
- Limited Information; women may lack a general knowledge about genital anatomy or have been poorly educated about sex. Kingsberg said one easy way to educate patients is to grab a mirror and show them their genital anatomy and explain how each part functions; she also said reading material can work, too.
- Specific Suggestions; suggest using lubricants or altering sexual positions to make sex more exciting.
- Intensive Therapy; if none of the previous suggestions have worked, refer your patients to psychotherapy or sex therapy. Having several go-to referrals available will save you time looking up names, suggested Kingsberg. Telemedicine/telepsychiatry is a good option for patients who live in rural areas, she said.

Women need to know that there is no "right" reason for having sex. Emotional intimacy, boredom, exercise, and their partner wants to are equally good reasons to have sex. As long as the sexual stimuli, whatever it may be, leads to arousal, and arousal leads to desire, things are working as they should. However, if desire is never reached, then there may be a bigger problem-be it physical or psychological-that needs to be addressed, advised Kingsberg.