A Naturalistic Prospective Open Study of the Effects of Adjunctive Therapy of Sexual Dysfunction in Chronic PTSD Patients Bela Chudakov, MD, Hagit Cohen, PhD, Michael Alex Matar, MD, and Zeev Kaplan, MD Ministry of Health, Mental Health Center, Faculty of Health Sciences, Anxiety and Stress Research Unit, Ben-Gurion University of the Negev, Beersheba, Israel. Abstract: Introduction: Post-traumatic Stress Disorder (PTSD) symptoms cause dysfunction in broad areas of patients’ lives and those of their families. Sexual dysfunction (SD) is common in these patients and aggravates their distress, af- fecting overall sexual activity, desire, arousal, orgasm, activity and satisfaction. PTSD clinic patients are frequently re- ferred for consultation and treatment in the SD clinic. This prospective naturalistic follow-up study of a random group of patients was intended to evaluate response to pharmacologic and psychotherapeutic interventions for SD, in terms of both sexual functioning and overall symptomatology. Methods: Ten patients fulfilling DSM-IV diagnostic criteria for PTSD (one woman and nine men) were recruited. Treatment for the sexual symptoms was tailored individually and was administered in addition to the continuing (stable) treatment in the PTSD clinic. Results: After two months of treatment for the sexual symptoms, statistically significant improvements in all domains of sexual functioning were observed. In parallel, statistically significant improvements in all domains of the Impact of Events Scale scores were observed, both on the avoidance and intrusive subscales. There were no significant differences in response to treat- ment in terms of time elapsed since the onset of PTSD, or the pattern or severity of sexual and PTSD symptoms. Con- clusions: The results of this modest study demonstrate the importance of relating to the SD of PTSD patients irrespective of the duration or severity of their disorder. In this mixed group of PTSD patients with varied duration of symptoms, both SD and PTSD core symptoms improved significantly in response to individually tailored adjunctive treatment of the SD. Introduction Post-traumatic stress disorder (PTSD) is a chronic syndrome reflecting a disorder of cognitive, emo- tional and physiological processing and/or recovery from the initial reaction to exposure to a potentially traumatic experience (PTE). The diagnosis rests upon three clusters of symptoms, a specified number of which must be present over a period of at least one month: 1) intrusive re-experiencing of the traumatic event in the form of nightmares and flashbacks, with an exaggerated response to cues; 2) persistent avoid- ance of stimuli associated with the trauma and a numbing of emotions; and 3) persistent symptoms of arousal and vigilance — an exaggerated startle re- sponse, increased physiological arousal and sus- tained preparedness for an instant alarm response (1). The estimated lifetime prevalence of PTSD among adult Americans is 7.8%, with women (10.4%) twice as likely as men (5%) to have PTSD at some point in their lives. This represents a small por- tion of those who have experienced at least one trau- matic event; 60.7% of men and 51.2% of women reported at least one traumatic event (2–6). In Israel, despite the ongoing terrorist attacks, the prevalence rate of PTSD is around 9–10% (7, 8). Characteristically, PTSD leads to emotional, so- cial and professional dysfunction, and deeply affects interpersonal, marital and sexual spheres. Although most therapists are aware of the SD accompanying PTSD, research has been sparse. Kaplan (9, 10) has shown that sexual problems are prevalent among PTSD patients. Letourneau et al. (11) reported that over 80% of PTSD patients studied were experienc- ing clinically relevant sexual difficulties. Impotence Isr J Psychiatry Relat Sci Vol 45 No. 1 (2008) 26–32 Address for Correspondence: Hagit Cohen, PhD, Anxiety and Stress Research Unit, Ministry of Health, Mental Health Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, POB 4600, Beersheba 84170, Israel. E-mail: hagitc@bgu.ac.il