Sexual dysfunction and sexually transmitted diseases are common; they are not confined to young adults, or to promiscuous individuals. Although such topics are often avoided by patients because of embarrassment, it is particularly important to ask patients about sexual function and activity and if they have any of the disorders known to predispose to sexual dysfunction. These include diabetes mellitus, alcohol abuse, chronic renal failure, marital difficulty or psychological disorder. Similarly, when sexually transmitted diseases are suspected, e.g. IIIV. hepatitis or pelvic inflammatory disease, a careful sexual history should be undertaken. In females, dyspareunia (pain related to sexual intercourse) or failure to achieve an orgasm are common and are frequently caused by. or lead to. psychological difficulties. In males, loss of libido, premature ejaculation and inability to maintain an erection may also be primarily psychological. Questions should be asked objectively with tact and sensitivity in a non-judgemental manner using a non-medical vocabulary to facilitate better communication. One approach would be to start by asking if sexual intercourse is satisfactory and, if it is not, enquire further. Some useful questions to ask are shown in Table 5.25. With practice, the clinician will become more comfortable taking a sexual history and patients should then feel less uncomfortable answering the questions. Even so. a sexual history may prove embarrassing and an alternative method is to ask patients to complete a confidential questionnaire detailing explicitly their sexual history and any problems they may have experienced. This may allow the clinician to identify the main problem earlier and to achieve a better rapport.
Was this article helpful?