I've looked back through some of the posts, but don't know exactly what one you are referring to on this, if you come across it let me know. But I'll answer this as well as I can from memory.
My Mom would be the one that you are thinking of who has tried drugs and had no success. She, is also going through menopause, which is why her Dr. suggested trying the meds...but her dr. also told her that they may not work....for her they did not. But realize also that my parents have a R that's been suffering for quite some time, moms menopause isn't the only cause of their problem, I only realized in the last few years how much their R was suffering. Their problems are largely due to lack of communication. As soon as my father finally said something about his dissatisfaction sexually (as well as a few other things) to my mother, my mom has tried to do things to meet his needs more. BUT the drugs have made no impact on her libido.....the communication however, has made an impact on their R. This past Christmas I could see more affection (not much, but more) between them which was nice. However, her libido is still very weak.
The friend I think you may be referring to was in a M for almost 10 years where she was berated constantly, had to put up with a loud overbearing H and was constantly having to play buffer between her H and her kids. In his eyes she NEVER did anything right....or at least that was her perception, she told me so. He made her constantly feel like no matter what she did, no matter what she tried....it wasn't good enough. Eventually she just stopped wanting him at all. She stayed in the M for her kids as long as she could....but she didn't want him anywhere near her physically....it got to the point that he repulsed her.
My friend is now in a very healthy R, and her libido is great. She's married to someone she can communicate with and even though their busy lives get hectic from time-to-time...they still manage to connect fairly regularly. She loves him, he fills her needs....and she wants him. That's how she works, that's how I work.
Now to the question you asked of me. If I were a MC and had someone in my office whose #1 need is "Complete Sexual Fulfillment". I'd have to ask that spouse to define what "Complete Sexual Fulfillment" means to him/her....literally, what is it? That phrase is tooo general, to open to individual interpretation, what it means for one person is most likely not the same definition for the other person....so that is a place to begin. Now, before you tell me I cannot alter the #1 need, defining it is not altering it. It is coming to an understanding of how each person would define it and understand it. In order to do this though....you also have to know how your the other person would define it, and that means asking them....not assumning you know how they would define it.
If you don't know how the other person would define "complete sexual fulfillment" and they don't know how you define it (specifically) then how are either of you going to know how to meet each others' needs? Or know that you are even working towards the same/simlar goals? You could be working towards your definition of it and completely be missing what her needs are and vice/versa.
CeMar, I'm pretty certain there isn't a therapist out there who could take what you just asked of me and give you a solution, from that requirement, that would meet both spouses #1 needs. Why? Because what you are asking would have to fit YOUR definition of it, but it may not fit your W's definition. Also, you would need to know exactly what your W's #1 need is....I don't know that.
So that leads me to a few question.....what is your W's definition of "Complete Sexual Fulfillment"? What is your W's #1 need?
If anyone else has any idea what their MC might say, jump on in...the water's fine! I'm pretty sure this is what our MC would say though, and I respect her highly.