Sexual counseling for women in the context of physical diseases: a teaching model for physicians.
BACKGROUND
Chronic medical conditions are frequently associated with sexual difficulties and problems, which are often underreported and underdiagnosed. Patients may feel that sexual problems in the context of disease are not important enough to be mentioned to their physicians, and physicians may feel uncomfortable and sometimes incompetent. Furthermore, the diagnostic criteria of Diagnostic and Statistical Manual of Mental Disorders-IV and International Classification of Diseases-10 are focused on the phenomenology of the sexual response without any specificity regarding diseases.


OBJECTIVE
To facilitate access for patients and physicians, we wanted to develop a tool for assessment and discussion of sexual problems in the context of disease. This tool should be broadly applicable, easy to use and learn for nonmental health professionals.


METHODS
Content analysis with respect to the integration of general sexological and disease-specific dimensions. Formulation of a diagnostic and therapeutic algorithm that can be used as a teaching tool.


METHODS
Based on our experience as a liaison-consultation sexological division of the university hospital of Basel, we analyzed the sexological diagnostic workup performed with the following group of female patients: women with benign gynecologic conditions; women with incontinence; oncological patients (mammary carcinoma, genital carcinoma); neurological patients (multiple sclerosis, spine injury, Parkinson's); patients with metabolic and endocrine disorders (diabetes, metabolic syndrome, polycystic ovarian syndrome); and patients with mental health disorders (depression, anxiety disorder, schizophrenia). We extracted the commonly used steps in the workup to construct a tool with easy-to-remember elements, which would help the physician to evaluate patients' sexual problems and plan for referral or therapy.


RESULTS
We could differentiate three diagnostic dimensions. The first were person-related preexisting factors, such as sexual satisfaction and function, age, body image, and general well-being. The second were the disease-specific implications, which could be summarized under the 8 Ds: Danger, Destruction, Disfigurement, Disability and pain, Dysfunction, Dysregulation, Disease load, and Drugs. The third was the patient's and partner's general response to the disease determined by affective response, coping style, body image impact, and changes in relationship dynamics.


CONCLUSIONS
Sexual problems are frequent in many clinical conditions, but are not yet a routine part of diagnostic workup and therapeutic planning. We have developed a tool to help physicians in different clinical settings to evaluate sexual problems of the female patients with specific clinical conditions in order to facilitate access to recognition and possible treatment.
Bitzer
Johannes
J
Department of Obstetrics and Gynecology, University Hospital Basel, Basel, Switzerland;. Electronic address: jbitzer@uhbs.ch.
Platano
Giacomo
G
Department of Gynecologic Social Medicine and Psychosomatics, University Hospital Basel, Basel, Switzerland;; Department of Clinical Psychology and Psychotherapy, University Hospital Basel, Basel, Switzerland.
Tschudin
S
S
Department of Obstetrics and Gynecology, University Hospital Basel, Basel, Switzerland.
Alder
Judith
J
Department of Gynecologic Social Medicine and Psychosomatics, University Hospital Basel, Basel, Switzerland.
D002908:Chronic Disease; D005260:Female; D006266:Health Education / Q000379:methods*; D006801:Humans; D008297:Male; D008962:Models, Theoretical; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians'; D015397:Program Evaluation; D012731:Sex Counseling / Q000379:methods*; D012735:Sexual Dysfunction, Physiological / Q000145:classification / Q000175:diagnosis* / Q000628:therapy; D020018:Sexual Dysfunctions, Psychological / Q000145:classification / Q000175:diagnosis* / Q000628:therapy; D013557:Switzerland