ABC of sexual health:Examination of patients with sexual problemsBMJ 1998; 317 doi: https://doi.org/10.1136/bmj.317.7173.1641 (Published 12 December 1998) Cite this as: BMJ 1998;317:1641
- John Dean
Examining a patient or couple with sexual problems involves standard procedures. However, it can sometimes be fraught with difficulties, often related to psychological and social factors not generally experienced in other situations.
Patients may anticipate the examination with dread and profound embarrassment or, conversely, may see it as a potential source of reassurance and relief. Doctors must be aware of the many popular myths about sex and that their patients may often hold quite idiosyncratic beliefs and fears, which will also need to be addressed.
It is important to explain at the outset how the examination, essential in all patients with a suspected physical problem, might help them and to tell them precisely what it entails. An unusual history, odd behaviour by either partner during assessment, inconsistent findings on examination, or unexplained bruising or trauma may alert you to an abusive relationship. Any suspicions should not be ignored, but great care and sensitivity are needed to address this issue.
Requirements for examination
Privacy, warmth, and an unhurried approach are essential
A third of women and a fifth of men prefer to be examined by a doctor of their own sex
Carefully consider cultural mores
It is prudent to offer patients a chaperone, both for reassurance and for medicolegal reasons
Assess patients holistically, excluding other diseases that may have a bearing on their sexual problem such as diabetes, hypertension, and depression
Patient preferences in examination
Many patients will find examination of the genitalia deeply embarrassing. Success will depend on the cooperation and confidence of your patient, and it is best to defer examination if the patient is uncomfortable and unable to relax.
It is good practice to offer to have a chaperone present for both male and female …