Male Sexual Dysfunction
How Can Physicians Manage these Problems Effectively?
Sexual function for both men and women depends upon the interplay of physical, psychological and relationship factors between each member of the couple. The "10 Minute Sexual History" uses the tradition medical approach to delineate a sexual concern (Table 1). Taking a focused sexual history of both partners' functioning once a sexual problem is uncovered can help develop a management plan (Table 2). The six squares of a 2 X 3 grid cover the main areas of a sexual functional inquiry for the couple. About half of partners of the identified patient will also have sexual dysfunction. A common example is dyspareunia due to postmenopausal atrophy and lack of intercourse for the partner of an aging man dealing with erectile dysfunction.
Most patients with a sexual concern will present on their own. Taking a history around emotionally loaded issues such as abuse, sexual orientation, and affairs may be most easily accomplished individually. But sex is not just a solo sport; usually it is shared with a partner. Treating the couple as the patient generates more diagnostic information from the "consultant" spouse, and allows both partners' concerns to be addressed. Looking at sexual problems as affecting the couple as a system increases chances for successful outcomes.
Couples are often hungry for information about sexuality. The attached readings suggest a number of resources, including "The New Male Sexuality" by Bernie Zilbergeld. Providing sex education is helpful for most couples, and sometimes it is all they need. It can prepare couples for, and is used extensively in more formal sexual therapy. The goal of sexual counselling is to help reduce sexual performance anxiety for both members of the couple, to allow the sexual response to occur without being overwhelmed by stress mediators such as adrenalin. Many physicians are uncomfortable in talking about sexuality with their patients, being afraid of "opening Pandora's Box". A graduated approach, using the PLISSIT model can aid physicians with their own comfort levels in helping patients' sexual concerns.
Conclusions
Physicians now have more treatment options than ever before to help their patients better deal with sexual dysfunction. The challenge remains to help physicians and their patients discuss sexual concerns as they do other medical problems, in a direct and forthright manner. This will lead to an integration of sexual health within a patient's overall medical care.
Last Modified: September 5, 2006
