Sexual problems are common and important in relation to physical illness and in general medical settings. There are several areas of medicine in which they present more commonly, including urology, gynaecology, diabetology/ endocrinology and genitourinary medicine. This is an obvious list, but in addition, sexual problems not infrequently present via infertility services and the range of oncology services.
Sexual problems carry with them a certain stigma. They are not easy problems to talk about, either for patients or for professionals. Patients may not mention them until they have already developed a therapeutic relationship with their liaison psychiatrist or other member of the multidisciplinary team, and they are also not likely to be volunteered without being prompted by appropriate questions. A clinician who asks such questions as a usual part of history-taking will detect twice as many sexual problems as one who waits for the patient to raise the subject (Burnap & Golden, 1967). This chapter aims to provide those interested in liaison psychiatry with a basic understanding of sexual dysfunction and a framework within which to be able to confidently assess, formulate and treat (or decide to refer on for treatment) their patients’ sexual dysfunction.
In both of the main psychiatric classification systems – ICD-10 (World Health Organization, 1992) and DSM-IV (American Psychiatric Association, 1994) – sexual problems are subdivided into three areas:
• sexual dysfunction
• gender identity disorders
The focus of this chapter is on sexual dysfunction. This is in recognition of the prevalence and importance of problems with sexual functioning, which may present to liaison psychiatrists frequently.
Prevalence of sexual dysfunction
Sexual dysfunction is common in both genders. Estimated rates of prevalence across the various sexual dysfunctions range from 10 to 52% in men and 25–63% in women (Frank et al, 1978; Spector & Carey 1990; Rosen et al, 1993; Feldman et al, 1994), so in a general sense in community populations these problems are clearly highly prevalent (Heiman, 2002).
Although such figures regarding classifiable sexual dysfunctions are available, perhaps what is really of clinical importance is sexual dissatisfaction. Just as with other areas of physical dysfunction, patients with sexual dysfunction (and their partners) vary with regard to the level of dissatisfaction reported. The relationship between these two areas is unclear.