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  • Disturbance in one or more aspects of the sexual response cycle.
  • Cause is often multifactorial, associated with medical conditions, therapies, and lifestyle.

General Considerations

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. Family physicians are ideally situated to address the sexual health needs of both men and women, and it is likely that the therapeutic options for addressing these needs will continue to expand over the next decade.

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 of sexual concerns and difficulties is even higher in clinical populations.

Recognition of sexual dysfunction is important whether specific treatment is available or desired. Sexual dysfunction 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 physical and emotional relationship satisfaction, as well as low general happiness. Despite this, only 10% of men and 20% of women with sexual dysfunction seek medical care for their sexual difficulties. The key to the identification of sexual function disorders is for the provider to inquire about their presence. A discussion of sexual health can be initiated in a variety of ways. Educational material or self-administered screening forms, placed in the waiting area or the examination rooms, send the message that sexual health is an important topic that is discussed in the clinician's office. Table 18-1 lists several questionnaires that can be incorporated into self-administered patient surveys for office practices.

Table 18-1. Sexual Health Screening Questionnaires.

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 ...

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