1/6. Sexual dysfunction: treat or refer.Sexual dysfunction is common in postmenopausal women, but because this problem may be caused by several factors, the primary need for these patients is an initial assessment and accurate diagnosis by the primary care provider. Listening to the patient and clarifying her concerns are important for defining the nature of the problem, its severity and duration, and her motivation for treatment. A complete physical evaluation, including a pelvic examination and measurement of postmenopausal hormone levels, may provide important information for structuring a treatment plan to address the patient's concerns. Providing postmenopausal women with reassuring reading materials and focusing on their specific concerns about sexual dysfunction will help reduce anxiety, as will physician suggestions keyed to the patient's individual needs. Alleviation of some menopause-related sexual function difficulties with prescription medications may be warranted, and referral to a specialist for further treatment and counseling may often be the best course of action for a primary care provider. Sexual problems in postmenopausal women are usually amenable to fairly simple interventions that are within the competence of primary care professionals. This paper provides the primary care provider with a perspective on the appropriateness of treatment compared with referral for women experiencing postmenopausal sexual dysfunction.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/6. Marital sexual dysfunction: female dysfunctions.The diagnosis, treatment, and referral of married women with sexual dysfunctions require information about the current physiologic deficit, previous sexual capacity, level of sexual desire, masturbatory experience, means of orgasmic attainment, preferred sexual partner, quality of marriage, husband's sexual capacities, and method of contraception. For classification purposes, the three basic physiologic deficits--excitement phase dysfunction, orgasmic phase dysfunction, and vaginismus--are subdivided into primary and secondary types. Primary dysfunctions represent longstanding developmental problems and are usually purely psychological in origin. Secondary dysfunctions occur after a period of normal sexual functioning and may be organic or psychological in origin. The actual determinants of dysfunctions are not well understood, but those factors commonly associated are discussed. The lack of knowledge about the nature of sexual desire, prevalence of dysfunctions, and significance of the inability to attain orgasm with coitus is emphasized. The physician's role in giving advice and treatment is defined.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/6. history-taking in sex counseling.A formula for obtaining a sexual history that has both diagnostic and therapeutic significance has been presented. By utilizing the relationship between effective stimulation of a sufficient quantity in a nuturing environment, the physician will be able to clarify what has either caused or is maintaining the sexual difficulty. It will be most beneficial if the physician explains the history-taking approach to the woman. In this way she can see how her answers relate to the problem and to the direction of treatment. A history-taking approach structured in this manner is most helpful to the physician and the woman.- - - - - - - - - - ranking = 3keywords = physician (Clic here for more details about this article) |
4/6. A clinical guide to the diagnosis and treatment of heroin-related sexual dysfunction.It is apparent that a significant degree of sexual concern exists in male and female heroin addicts in the predrug, drug and postdrug periods. The Sexual Concerns and Substance Abuse Project recommends that each opiate abuser entering in to treatment has a brief sex history taken and, if a primary or secondary sexual dysfunction is discovered, then additional evaluation is indicated. Furthermore, the Project stresses the importance of educating the patient to the physiological, as well as psychological, relationship between heroin-related sexual dysfunction and concomitant side effects. For example, in women chronically abusing high doses of heroin, one may not only see a reduction of sexual desire and performance, but also irregular menstrual cycles, and occasionally, amenorrhea, as a result of the depressive effects of the opiate on pituitary hormones. The woman may misinterpret this physiological effect and believe that such changes in her menstrual cycle are irreversible, and that she is sterile. Following the evaluation and patient education phase, the findings obtained from the evaluation of the drug cycle, as it relates to the sociosexual response cycle, should be incorporated into the overall treatment approach for counseling the opiate abuser. When a specific sexual dysfunction exists, particularly if it predates the heroin involvement, referral to a qualified sex therapist is often indicated, to work in co-therapy with the drug counselor and the referring physician. Greater awareness of heroin-related sexual dysfunction may help reduce the relapse rate back to heroin as well as improve the quality of the individual's life during the recovery period.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/6. Sexual health care clinician in an acute spinal cord injury unit.This article introduces the role of the sexual health care clinician, a nonphysician specialist trained to diagnose and treat sexual dysfunctions of disabled persons. Under medical supervision, the clinician is part of the treatment team in an acute spinal cord injury unit, a general rehabilitation center and an extended care unit. The clinician's role includes direct patient care; education for professionals, students and community agencies; liaison with other rehabilitation groups; and research. The process of sexual rehabilitation is conceptualized and experience with the specialty in an acute setting is described. Experience indicates that sexual assessment, diagnosis and management is a technical specialty which requires in-depth training. The major contributions of the service are an early legitimization of sex-related concerns; the crystallization of physiologic emotional and social capabilities and needs; and the specific instructions for experimentation with various sexual alternatives.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/6. Marital sexual dysfunction: erectile dysfunction.All clinicians are occasionally consulted by men complaining of impotence. The history is the most important step in the differential diagnostic process for this symptom. Answers to four basic questions enable the physician to recognize classic psychologic and organic patterns. In addition, these questions provide clues as to the cause of the dysfunction. Physical and laboratory examinations are usually required to identify the specific organic cause. Traditional prevalence figures for impotence may no longer be valid. This topic awaits epidemiologic data that reflect current diagnostic sophistication. Individual treatment approaches to both organic and psychologic impotence must counteract the adverse influence of performance anxiety.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |