Problems with sexual function

Editor—The lack of undergraduate and postgraduate training in managing sexual problems is one reason for the under-recording in general practice notes of consultations about sexual problems.¹ The medical model of history, examination, diagnosis, and treatment is a poor tool when faced with “dysfunction” of what is fundamentally a psychosomatic event—sexual activity and orgasm.

This is fertile ground for the pharmaceutical industry to exploit. When a doctor feels all at sea the temptation to reach for “a treatment,” a tangible solution for the patient, can be very strong. The medicalisation of female sexual disorder feeds off this dilemma, but as with the treatment of erectile failure with sildenafil and similar drugs, ignoring the underlying dynamics and merely treating the symptom is not a satisfying solution for many patients.

However, training is already available. The Institute of Psychosexual Medicine trains doctors in skills that promote insight and deeper understanding of sexual problems whatever the clinical setting. It does so by using a holistic approach to mind and body that may include physical examination, combined with understanding and interpretation of the dynamics of the consultation.

Training at the institute can lead to specialist qualification but is especially useful for doctors wishing to increase their skills and confidence in managing these problems in the normal workplace. Any doctor, whether a general practitioner, gynaecologist, family planning doctor, genitourinary doctor, or psychiatrist, who is interested in training or enhancing their skills, should contact the institute's office (www.ipm.org.uk).