ABC of sexual health:Examination of patients with sexual problems

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.