ESSENTIALS OF DIAGNOSIS
Disturbance in one or more aspects of the sexual response cycle.
Cause is often multifactorial, associated with medical conditions, therapies, and lifestyle.
Sexual dysfunction is a disturbance in one or more of the aspects of the sexual response cycle. It is a common problem that can result from communication difficulties, misunderstandings, and side effects of medical or surgical treatment, as well as underlying health problems. Because sexual difficulties often occur as a response to stress, fatigue, or interpersonal difficulties, addressing sexual health requires an expanded view of sexuality that emphasizes the importance of understanding individuals within the context of their lives and defining sexual health across physical, intellectual, emotional, interpersonal, environmental, cultural, and spiritual aspects of their lives and their sexual orientation. Sexual dysfunction is extremely common. A survey of young to middle-aged adults found that 31% of men and 43% of women in the general population reported some type and degree of sexual dysfunction. The prevalence is even higher in clinical populations.
Recognition of sexual dysfunction is important. It may be the initial manifestation of significant underlying disease or provide a marker for disease progression and severity. It should be a consideration when managing a number of chronic medical conditions.
Sexual dysfunction is positively correlated with low relationship satisfaction and general happiness. Despite this, only 10% of affected men and 20% of affected women seek medical care for their sexual difficulties. The key to identification of sexual function disorders is to inquire about their presence. A discussion of sexual health can be initiated in various ways. Educational material or self-administered screening forms convey the message that sexual health is an important topic that is discussed in the clinician’s office. Table 19–1 lists several questionnaires that can be incorporated into self-administered patient surveys for office practices.
Table 19–1.Sexual health screening questionnaires. |Favorite Table|Download (.pdf) Table 19–1. Sexual health screening questionnaires.
Sexual Health Inventory for Men (SHIM)
International Index of Erectile Function (IIEF)
World Health Organization (WHO) Intensity Score
Androgen Deficiency in the Aging Male (ADAM)
Female Sexual Function Index (FSFI)
Sexual Energy Scale
Brief Index of Sexual Function Inventory (BISF-W)
Changes in Sexual Functioning Questionnaire (CSFQ)
Sexual history can be included as part of the social history, as part of the review of systems under genitourinary systems, or in whatever manner seems most appropriate to the clinician. There are many other opportunities to bring a discussion of sexual health into the clinical encounter, as outlined in Table 19–2. Clinician anxiety may be reduced by asking the patient for permission prior to taking the sexual history.
Table 19–2.Sexual health inquiry.