Presentation

Some women will colme into the surgery and announce directly that they have a sexual difficulty. Often presentation is more covert and patients will come with a “calling card”, not telling the doctor directly about the real reason for their attendance. Frequent attendees, those patients with thick case notes for no particular reason, and those with vague symptoms, may all be trying to pluck up the courage to tell the doctor or nurse their real difficulty and doctors need to be alerted to an underlying problem. Sexual difficulties may be announced with the “hand on the door” after a patient has worked her way through a list of trivial symptoms. Consultations such as this are very difficult within the time constraints of the general practice consultation, but it is important that the problem is addressed immediately or a firm follow-up arranged. If this is not done, the “moment” may be lost. It is also important at the outset to establish whether a patient wants treatment for her problem or whether she has been brought or sent by her partner. If the patient has been “sent”, the prognosis is much worse and she may not even want to engage in any therapy.

Incidence

As with all human behaviour, sexual difficulty is hard to quantify. There have been many studies assessing the prevalence of sexual difficulty amongst groups attending specialist clinics, but it is difficult to estimate the number of women with a sexual difficulty in the general population. The significance of any dysfunction is also hard to measure. On the one hand, women will report sexual dissatisfaction even if the problem lies primarily with their partner. On the other hand, they may not want treatment for their own difficulty if they do not have a partner or if they have a low sex drive.

A recent study in four general practices in England published the results of a postal questionnaire sent to a study population of 4000 men and women. Responses were received from 979 women (with a mean age of 50); 41% of these women reported a current sexual problem. The most widely reported problems were vaginal dryness (186) and infrequent orgasm (166). Of the men, 34% also reported a sexual difficulty. In men the proportion with problems increased with age but there was no such trend with women. Of responders with a sexual problem, 52% said that they would like help with this but only 10% (50) of this group had received such help. There therefore does appear to be a large unmet need within the general practice population. Although doctors are quite used to talking about other intimate areas of life, they often find it difficult to discuss sex.

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