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Drink, sir, provokes the desire, but it takes away the performance.
WILLIAM SHAKESPEARE (1564–1616), MACBETH, ACT 2, SCENE 1
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Sexual health is the ability to embrace and enjoy our sexuality throughout our lives. Our sexuality is a fundamental human experience that encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction.1
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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 and prescribe so many drugs, we must be aware of the possible implications of their various effects on sexual health.
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Several studies have demonstrated that sexual concerns and problems are common, with a prevalence ranging from 20–40%. Difficult problems are summarised in TABLE 116.1. There is also evidence that health professionals do not discuss sexual concerns in consultations as often as patients would like.
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Sexual dysfunction can be the bodily expression of many sorts of distress and requires consideration of biological, psychological, sociocultural and relationship factors. 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.
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OPPORTUNISTIC SEXUALITY EDUCATION
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The family doctor has many opportunities to provide education in sexuality throughout the lifelong care of the patient and it is wise to have a strategy that matter of factly incorporates enquiries and information about sexual health.
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antenatal and postnatal care
contraceptive requests
parents concerned about their children’s sex play
serious illness—medical and surgical
adolescent problems
menopause problems
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PRESENTATION OF SEXUAL CONCERNS
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Although some patients may present directly with a complaint of sexual dysfunction, many will be less direct and use some other pretext or complaint as a ‘ticket of entry’ for their sexual concerns (see TABLE 116.2). Despite a seemingly terse approach the issue must be recognised and treated with considerable importance. This may mean scheduling an appropriate time to discuss the concerns.
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