Sexual function problems and help seeking behaviour in Britain: national probability sample survey
BMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7412.426 (Published 21 August 2003) Cite this as: BMJ 2003;327:426All rapid responses
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I read this article with great interest. The research that Relate has conducted recently (due to be published in the Journal of Sexual and Relationship Therapy) supports many of the findings in the article.
We have learnt that in a third of all Relate's sex therapy cases both partners have at least one sexual dysfunction as defined by DSM IV. For women the most common problem was lack of sexual desire and for men it was erectile insufficiency. Relate's therapists are used to working with couples with medical problems as approximately half of all cases involved a medical problem contributing to or causing the sexual problem.
Relate is the largest single provider of a specialist psychosexual therapy service to couples and individuals. This service is available throughout England Wales and Northern Ireland. G.P.s can refer patients to their local Relate centre or suggest the patient makes the contact themselves. Approximately a quarter of Relate's clients with a sexual problem have been referred by their doctor or another health care professional.
Relate also offers training in psychosexual therapy which is open to doctors and other health care professionals working in relevant disciplines. The training involves five residential modules which can be at weekends. The training is approved by the British Association of Sexual and Relationship Therapy (BASRT). This means that students who complete the course can gain professional accreditation if they choose. The strength of Relate's course is that it puts sexual problems into the wider context of the couple's relationship. The meaning of the sexual problem to the couple is addressed as well as the possible medical and psychological causes. This enhances the chances of a successful outcome to the therapy. If you want to find out more about the course contact me at jane.roy@relate.org.uk
Competing interests:
None declared
Competing interests: No competing interests
While I applaud the authors of this piece for trying to identify the
estimates of sexual problems - the major problem is in defining what is
the "problem". The prevalence of "lack of interest in sex" for women which
lasted at least one month in the past year was found to be 40.6%; why is
this necessarily a problem? Of importance too is the absence in this study
of concommitent depression and anxiety measures that may be related to
loss of interest.
For many women, lack of interest in sex has more to do with the
context of their lives and may in fact be protective. If a woman does not
have a partner or is stressed with multiple role demands, lack of interest
in sex may actually be adaptive in that she can focus on other important
issues in her life. And why were participants not asked whether they saw
this as a "problem"?
Perhaps the real "problem" is the inclusion of loss of desire as a
diagnostic classification in the ICD-10 codes.
Respectfully,
Anne Katz RN Ph.D.
Competing interests:
None declared
Competing interests: No competing interests
Indicators of severity of sexual dysfunction
EDITOR––Mercer et al. make aware of the high proportion of men
(34.8%) and women (53.8%) suffering from at least one sexual problem in
the previous year,¹ men most often from lack of interest in sex, premature
orgasm and fear of failure. To come to a more adequate estimate of the
prevalence of sexual problems, the authors use ‘duration of problems’
(≥ six months in the previous year) as indicator of severity. In
this case, 6.2% of men had persistent sexual problems. In a general
practice based study on sexual problems of male patients,² we used the
frequency of the problem as another indicator of severity. Even if we
consider only those patients who reported to suffer from one or more
sexual problems often (15%) or always (5%), the rate underlines sexual
dysfunction as a major public health problem.
Mercer and colleagues consider health seeking behaviour as a further
indicator of severity. This indicator tends to underestimate the problem:
Patients may find it difficult to frankly address sexual problems in
general practice. Almost half of the respondents (133/295) in our study
preferred their physician to initiate any discussion about sexuality.
Doctors, however, reported that they initiated discussion about sexual
problems only sometimes (53%) or seldom (37%) during the consultation.
Consequently, only 12% of the responding patients had already consulted
their family physicians because of sexual problems.²
A further indicator of the severity of sexual problems may be that
18% of the patients in our study who suffered from sexual problems
experienced depression and depression-like symptoms and 14% sleeplessness.
These symptoms may be one point of reference for general practitioners to
start a conversation with their patients about sexuality.
Wolfgang Himmel
senior lecturer
whimmel@gwdg.de
Michael M. Kochen
professor of general practice
Department of General Practice,
University of Göttingen, Germany
¹ Mercer C H, Fenton K A, Johnson A M, Wellings K, Macdowall M,
McKanus S, Nanchahal K, Erens B. Sexual function problems and helping
seeking behaviour in Britain: national probability sample survey. BMJ
2003;327:426-7
² Aschka C, Himmel W, Ittner E, Kochen M M. Sexual problems of male
patients in family practise. J Fam Pract 2001; 50:773-778
Competing interests:
None declared
Competing interests: No competing interests