Editorial by Adler

Sexual problems present in various ways, many indirect or covert. Patients do not like to come straight to the point. They fear looking stupid by using wrong words, or giving offence by being too explicit, or they have no way of conceptualising what it is that is wrong. A doctor can find himself or herself fumbling around in a slightly mad conversation in which nobody understands what is being said. A common language needs to be established first, particularly in sexual medicine, followed by a good history and a careful examination, if appropriate, before an assessment of relevant management can be made. Recurrent gynaecological or urological complaints, insomnia, depression, joint pains, and other symptoms have all been used as covert presentations of sexual problems.

Man, Woman and Fish by Emily Young

Once the presence of a sexual problem has been established, its severity and importance to the patient need to be understood before the most appropriate course of management can be offered. This can vary from straightforward education, by simply giving accurate information, to referral for psychiatric assessment (fortunately very rare). History taking is therefore the paramount skill …