Sex is a problem for everyone…. Indeed, for a couple of weeks or a couple of months, or maybe even for a couple of years, if we are lucky, we may feel that we have solved the problem of sex. But then, of course, we change or our partners change, or the whole ballgame changes, and once again we are left trying to scramble over that obstacle with this built-in feeling that we can get over it, when actually we never can. However, in the process of trying to get over it, we learn a great deal about vulnerability and intimacy and love…. (Peck, 1993, Further Along the Road Less Traveled)
Primary care practitioners are in an optimal position to evaluate sexual problems, as they often have the most comprehensive and long-lasting relationship with the patient. In contrast to most other medical diagnoses, however, it is the patient who usually defines when a sexual problem exists. Although referral to medical or mental health specialists (or both) may be indicated in certain situations, many problems can be diagnosed and treated by the primary care practitioner. When questions about sexuality are approached in an open, matter-of-fact manner, most patients are relieved and respond positively. They appreciate the affirmation that these issues are valid and important, whether or not they have current sexual concerns or are sexually active (Table 29–1).
Table 29–1. Sexual concerns of patients. |Favorite Table|Download (.pdf)
Table 29–1. Sexual concerns of patients.
- Common sexual worries about normalcy, such as: Am I O.K.? What is a "healthy" sex life? How do I compare? Is my sex life satisfactory?
- Sexual identity questions relevant to lifestyle, orientation, and preference.
- Developmental issues of sexuality for children, adolescents, parents, and the elderly, including the development of gender identity, masturbation, genital exploration, child sex play, sexuality, and the single life, marriage, divorce, and death of a partner.
- Reproductive concerns covering infertility, family planning, contraception, pregnancy, and abortion.
- Sexual desire, satisfaction, and dysfunctions, such as a couple's differing levels of desire, and problems with vaginal lubrication, erections, orgasm, and pain.
- Sexual changes due to physical disability, medical illness, and treatment.
- Sexual trauma resulting from molestation, incest, and rape.
- Safe sex practices: AIDS and STDs.
- Paraphilias and sexual compulsions.
The authors would like to thank Linda Perlin Alperstein, LCSW, Jean M. Bullard, RN, MS, Lisa Capaldini, MD, Deborah Grady, MD, MPH, & William B. Shore, MD, for reviewing earlier drafts of this chapter. Our appreciation especially goes to the coeditors of this book for their valuable comments and suggestions. Finally, the contributions to the study of sexuality by Raymond C. Rosen, PhD, have been inspiring to us.
To provide patients with helpful responses to their sexual health concerns health professionals need to have the following:
- A willingness and ability to discuss sexual topics comfortably....