Assessing problems

Men are more likely than women to present with and receive treatment for sexual problems. Nevertheless, they usually find them very difficult to talk about, and an initial perception that their problem is being dismissed can considerably delay or prevent their seeking further help. Time spent establishing as clearly as possible the nature of the problem is well spent, as it should lead to more effective treatment and may be therapeutic in itself. Likewise, talking to the partner can reveal a very different picture and can substantially alter management as well as have a therapeutic impact.1

Sometimes quite simple interventions—information, reassurance, contraceptive advice, or an opportunity to talk to a member of the primary care team with some basic problem solving or non-directive counselling—can resolve problems that have been a source of considerable distress to patient and partner. Suggesting sources of self help information such as books on sexuality can also be valuable.

When the problem persists despite primary care intervention, further help from other services can be sought, although the provision of services for sexual problems in Britain is variable and rarely enough to meet demand. Optimum assessment and treatment is provided in a multidisciplinary setting, but such clinics are scarce and most patients will be referred to services that have a particular approach. The choice of where to refer a patient will therefore have a critical effect on treatment and, possibly, outcome.

Classification of sexual dysfunction

The accepted diagnostic categories for sexual dysfunction described in ICD-10 (international classification of diseases, 10th revision) and DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth revision) do not reflect the reality of sexual dysfunctions in the clinical setting. When these classifications are used it must be remembered that