Dr Raffi (Psychiatric Bulletin, June 2007, 31, 233–234) has raised some interesting points about sexual dysfunction among patients of south-east Asian background. This is an issue which psychiatrists working in south-east Asian countries face routinely in their clinical practice.

We recently carried out a survey among psychiatric trainees in a teaching hospital in Peshawar, Pakistan enquiring about their awareness and understanding of psychosexual problems in psychiatric patients. Sixteen doctors (15 males, 1 female; age range 28–42 years) completed the questionnaire and, although all were aware of the existence and likely causes of sexual dysfunction in psychiatric patients, only 6 said that they were routinely carrying out assessments of psychosexual functioning. Although most doctors (11 out of 16) felt comfortable about assessing such patients, they thought that patients were very uncomfortable talking about problems of such a sensitive nature. Nearly all doctors (14 out of 16) thought that the patients were unable to openly express themselves about their sexual problems. The most common problems identified by doctors were reduced libido, erectile dysfunction and premature ejaculation. Only 6 doctors thought that patients were getting adequate help for their psychosexual symptoms; the remaining 10 said that patients were just given reassurance.

All 16 doctors felt that there was a need for specific training for the adequate assessment and management of sexual dysfunctions in a manner which was culturally sensitive and acceptable to these patients. The stigma associated with psychiatric problems in general, owing to cultural and religious barriers, was further compounding the whole issue.

It is therefore pertinent that psychiatrists, especially in low- and middle-income countries, spend more time with patients to try to allay their anxieties about their psychosexual problems.