Sexuality and U
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Health-Care Professionals

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Sexual Dysfunction

 

Sexual problems are common. The prevalence of sexual dysfunction is 43% for women and 31% for men in a large American sample.(1) Erectile dysfunction increases as men age, with 52% of men age 40 - 70 having some degree of impotence.(2)

Female Sexual Dysfunction

Physicians who deal with women, whether family practitioners or Ob-Gyns, often hesitate to bring up sexual issues with patients. However, studies in specific groups of patients such as diabetics and cancer patients have shown that patients not only want to talk about sexual issues, but also expect physicians to bring up the subject. Physicians are often uncomfortable with these issues for various reasons that will be discussed below. Physicians who do talk about sexual issues with patients tend to discuss these issues more frequently with men than with women, and with younger than with older patients. Studies have indicated, however, that there is no age group above which sexual concerns are not important.

Taking a sexual history benefits not only the patient but also the physician. In one study involving general internists, taking a sexual history yielded information of medical importance in 26% of cases, and affected treatment and follow-up plans in 16%. Similar studies have not been undertaken in the gynecological population but one might speculate that based on the nature of gynecological practice, these figures would be even higher in the gynecological population. For that reason alone, taking a sexual history should be viewed as an essential component of female medical care.

There is still a lot we don't know about female sexual function. While there has been a marked resurgence in research interest in the past few years, we are still at the stage of studying rats and rabbits. One might argue that we really shouldn't even have been classifying female sexual dysfunction into distinct categories. Masters and Johnson described the original Physiologic Sexual Response model in four phases, arousal, plateau, orgasm and resolution. Kaplan added a desire phase that preceeded arousal and described the Triphasic Sexual Response that included  desire, arousal and orgasm, now labelled the Linear Model of sexual response. Basson introduced the Circular or Intimacy based model, emphasizing the responsive nature of female sexuality

Dysfunctions of the desire phase (as defined in the DSM-IV) include hypoactive sexual desire, and sexual aversion disorder. Dysfunctions of the arousal phase include female sexual arousal disorder as well as dyspareunia and vaginismus. Orgasm phase disorders include female orgasmic disorder. In addition, there are the dysfunctions due to general medical conditions and substance-induced dysfunctions.

Male Sexual Dysfunction

Sexual concerns are often associated with other medical illness, or their treatment such as hypertension, diabetes, and vascular disease . A multidisciplinary study found that pathophysiological factors were present for at least 33% of men and 10% of women presenting for sexual counseling.3 Identifying sexual concerns changes medical treatment. In a general medicine outpatient clinic, a controlled trial compared to usual care, asking patients "Do you have any sexual concerns?" uncovered new, important medical information for 26% of patients, resulting in changes in medical treatment 16% of the time.4 Patients want their doctor to treat their sexual problems. Patients see physicians as the most appropriate health professionals to aid them in managing sexual dysfunctions.5