Intended for healthcare professionals

Clinical Review

ABC of sexual health:Examination of patients with sexual problems

BMJ 1998; 317 doi: (Published 12 December 1998) Cite this as: BMJ 1998;317:1641
  1. 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.

    It is important to explain at the outset precisely what an examination entails. (Mercury treatment for venereal disease, circa 1500)

    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 …

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