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The functional form of impotence fills the coffers of the quacks, and swells the list of suicides.

Rutherford Morrison (1853–1939)

Drink, sir, provokes the desire, but it takes away the performance.

William Shakespeare (1564–1616), Macbeth, Act 2, Scene 1

Family doctors are often asked to provide advice and help for sexual concerns and are continually challenged to detect such problems presenting in some other guise. Since we deal with so much illness, including debilitating problems, and prescribe so many drugs, we must be aware of and sensitive to the possible implications of their various effects on sexual health.

Sexual disorders can be considered in three major groups: sexual dysfunction, sexual deviation and gender role disorders. This chapter largely confines itself to a discussion of sexual dysfunction.

Sexual dysfunction

Sexual dysfunction in men refers to persistent inability to achieve normal sexual intercourse while in women it refers to a persistent lack of sexual satisfaction.1

Several studies have demonstrated that sexual concerns and problems are common, with a prevalence ranging from 10–70% of the population.2 Difficult problems are summarised in Table 118.1. These studies have also indicated that patients are certainly willing to discuss their sexuality and wish their family doctors to become involved in counselling and management of their problems. Between 25% and 30% of sexual difficulties have an organic cause, while the remainder are emotional or psychogenic in origin.3 The unique place of general practice and the family doctor provides ideal opportunities to address the sexual concerns of patients as the family doctor often has considerable insight into the family dynamics and first-hand perspective of the individuals involved.

Table 118.1

Sexual dysfunction: difficult problems

The most common problem influencing an effective outcome is difficulty in communication between doctor and patient, which prejudices effective history taking and counselling. The problem is not content-related, much of which is based on commonsense, but the ubiquitous problem of communication.

If, as a practitioner, you counsel on the assumption that astounding ignorance about sexuality still exists in our society, you will be amazed at the results and at how relatively simple it is to help so many confused people who often have unrealistic expectations of their partners and themselves.

Opportunistic ...

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