Cookie policy notice

By continuing to use this site you agree to our cookies policy below:
Since 26 May 2011, the law now states that cookies on websites can ony be used with your specific consent. Cookies allow us to ensure that you enjoy the best browsing experience.

This site is intended for health professionals only

At the heart of general practice since 1960

Key learning points on sexual dysfunction



Key questions: Erectile dysfunction

+ ED occurs on average three years before the onset of coronary symptoms and five years before the coronary event.

+ Oral therapy produces a mean improvement of six to seven points on the Sexual Health Inventory for Men.

+ Antidepressants, antipsychotics, and antihypertensives are the drugs most likely to cause ED.

+ Diagnosing and treating low testosterone with gels, long-acting injection and patches is within the scope of most GPs.

+ Depression in a population with ED is 25%, compared to 13% in an age-matched sample.

+ All men with ED should be investigated by lipid profile, fasting glucose and morning testosterone.

+ Oral therapies are effective in around 75% of patients.

+ But oral therapies are only effective in about 55% of men with diabetes and 30% of men who have undergone a radical prostatectomy.

+ Tadalafil at 5mg daily has potential benefits in improving endothelial function.

Ten top tips on psychosexual therapy

+ PDE5 inhibitors require sexual stimulation to be effective.

+ Addressing sex as a standard part of history-taking will ‘normalise' the consultation.

+ There are particular disease areas, such as cancer, that can have an impact on sexuality.

+ Altered body image after surgery may need to be discussed rather than the subject avoided.

+ Encourage couples to bathe or shower together, as this allows intimate touch and the opportunity to experience different sensations.

+ Illness, especially when associated with stomas or dressings, may alter the smell of a partner and be off-putting.

+ If there are limited psychosexual services locally, GPs can try referring through Relate.

Peyronie's disease

+ 40-50% of cases of Peyronie's disease are complicated by ED.

+ Penile plaques are most commonly found dorsally – occurring in 66% of cases.

+ The active phase of the disease occurs between one and six months from disease onset.

+ The quiescent phase of disease starts nine to 12 months after onset.

+ About 12-13% of patients will spontaneously improve over time.

+ Doppler ultrasound can be used to assess vascular abnormalities.

+ Penile implants can be used for severe deformities with ED.

Orgasmic disorders in men

+ There are four premature ejaculation syndromes: lifelong PE, acquired PE, naturally variable PE and inconsistent PE.

+ The only currently available medical treatments are the off-label use of SSRIs and the tricyclic antidepressant clomipramine.

+ A failure of ejaculation often presents as inhibited ejaculation or retarded ejaculation.

+ If a man can masturbate and ejaculate or ejaculate with oral stimulation or in specific positions, it would suggest the problem is psychological.

+ Men with no ejaculation should be referred for urological assessment.

+ For men who reach orgasm with no ejaculation, arrange for the first urine sample after sex to be analysed for presence of sperm.

+ Indomethacin and diltiazem may be helpful for orgasmic headache.

Dyspareunia

+ Up to 90% of women attending with gynaecological complaints have a sexual issue.

+ Dyspareunia is commonly divided into superficial and deep pain.

+ Vulval pain syndrome has a prevalence of 2-10%.

+ Vaginal infections can cause pain that develops into a chronic pain cycle.

+ An ultrasound scan can identify those needing diagnostic laparoscopy.

+ Triple swabs – high vaginal, endocervical and endocervical chlamydia swabs – are standard in sexually active women with deep dyspareunia.

+ Local anaesthetic gels used 20-30 minutes before penetration help some women.

+ Skin disorders such as lichen sclerosis are rapidly resolved with steroid creams but are often recurrent.

Click here to start the assessment 3 CPD hours

Rate this article 

Click to rate

  • 1 star out of 5
  • 2 stars out of 5
  • 3 stars out of 5
  • 4 stars out of 5
  • 5 stars out of 5

0 out of 5 stars

Have your say