Archive for August, 2014

Sexual status examination

Thursday, August 28th, 2014 No Commented
Under: Health care

The sexual status examination (SSE) is the most important assessment tool at the clin-ician’s disposal and is most evocative of the “review of systems” common to all aspects of medicine. A focused SSE critically assists in understanding and identifying the immediate cause of the ED (i.e., the actual behavior and/or cognition causing or contrib-uting to the sexual disorder). The clinician focuses on finding potential physical and specific psychosocial factors relating to the disorder. The clinician pursues a description of the sexual symptom and the history of the sexual symptom in detail. All patients assessed for sexual difficulties should be screened briefly for concurrent psychopathol-ogy. This does not need to be in-depth pursuit, unless there is evidence of a significant psychiatric disorder.

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Information about the onset and progression of symptoms as well as a detailed descrip-tion of the patient’s sexual symptom should be obtained. The physical and emotional cir-cumstances surrounding the onset of a difficulty are important for the assessment of both physical and psychological causes. If these details are not spontaneously offered, the clinician must elicit them. By juxtaposing detailed questions about the patient’s current sexual practices and history, an understanding of the causes of dysfunction and noncom-pliance can be unveiled.

A detailed analysis of the patient’s current sexual behavior and the couple’s erotic inter-action can help eliminate potential organic causes. Additionally, the sexual information evoked in SSEs helps anticipate noncompliance with medical and surgical interventions. Modifying immediate psychological factors may result in the need for less medication  Generally, urologists and PCPs intervene with pharmacotherapy and brief sexual coach-ing, which address immediate causes (e.g., insufficient stimulation) directly and inter-mediate issues (e.g., partner issues) indirectly and are rarely focused on deeper issues (e.g., sex abuse). In fact, a referral is usually appropriate when deeper psychosocial issues are primary.

Early in the SSE, a physician should obtain a description of a recent experience that incorporates the sexual symptom. One question helps elucidate many of the immediate and remote causes: “Tell me about your last sexual experience.” The clinician can quickly identify common immediate causes of ED from the patient’s response. Several frequently identified contributors to ED include insufficient stimulation (e.g., a lack of adequate friction), a lack of subjective feelings of arousal, fatigue, and negative thinking. Sex is fantasy and friction, mediated by frequency. To function sexually, men need sexy thoughts and not just adequate friction. Although fatigue is a common cause of sexual dys-function in our society, negative thinking/anti-fantasy is also a significant contributor.