[Drink,] sir, provokes the desire, but it takes away the performance. WILLIAM SHAKESPEARE (1564–1616), MACBETH, ACT 2, SCENE 1
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
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.
2Sexual dysfunction occurs when an individual is unable to enjoy their sexuality as they would wish.
Several studies have demonstrated that sexual concerns and problems are common, with a prevalence ranging from 20–40%. Sexual difficulties are summarised in TABLE 108.1. There is also evidence that health professionals do not discuss sexual concerns in consultations as often as patients would like.
Table 108.1Sexual difficulties and dysfunction2 ||Download (.pdf) Table 108.1 Sexual difficulties and dysfunction2
lack of libido: 4 in 10 women
orgasmic difficulties: 1 in 3 women
painful intercourse (dyspareunia, vaginismus): 1 in 10 women
concerns about labia
lack of libido: 1 in 4 men
erectile dysfunction: 1 in 5 men
premature/delayed ejaculation: 1 in 4 men
concerns about penis
sexual desire discrepancy
substance/medication-induced sexual dysfunction
compulsive sexual behaviour
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.
PRESENTATION OF SEXUAL CONCERNS
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 108.2). 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.
Table 108.2How sexual issues may present in family practice3 ||Download (.pdf) Table 108.2 How sexual issues may present in family practice3
Minor non-sexual complaint—‘entry ticket’
Specific sexual concern
Marital or relationship problem
Non-sexual problem (as perceived by the patient)
Sexual enquiry as part of illness management
Sexual enquiry as part of total health check-up