ABC of mental health: Psychosexual problems

Relationship and sexual problems

Sexual problems must be evaluated in terms of the relationships in which they are manifest. Relationships can be classified as stable or unstable and satisfactory or unsatisfactory, and most relationship problems can be thought of as including difficulties with communication, conflict, and commitment. Difficulties tend to vary at different stages of a longstanding relationship such as marriage, accompanying the couple's advancing years. Many sexual problems occur because of threatened or actual rupture of a relationship or separation (including death of a partner).

Close relationships are shaped by the experiences and expectations of the couples and by legal and cultural influences. Three areas commonly require evaluation: implications of unmarried cohabitation rather than marriage, different traditions of relationship of different cultural groups (such as whether marriage partners should be arranged by parents or chosen by the young people), and strong religious beliefs.

Sexual problems

Four main classes of sexual problems are encountered in clinical practice—sexual dysfunctions (the most common), sexual drive problems, gender problems, and sexual variations and deviations. About 10% of patients attending general practice have some kind of current sexual or relationship difficulty. Three general points are important:

• People vary greatly in the quantity and type of sexual activity they seek to undertake, and in its importance for them

• Whenever a substantial relationship difficulty accompanies sexual dysfunction, one partner is usually the referred patient, but a joint meeting with both partners should be offered. The prognosis is poor if both do not attend for joint meetings

• While it is often easy to identify specifically sexual aspects of a problem, it is difficult to evaluate a couple's relationship from a brief assessment.