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Chapter 85: Sexual Dysfunction in Patients with Disabilities

Vijita Patel; Kelly M. Scott

INTRODUCTION

SEXUALITY IS A BASIC HUMAN INSTINCT. THIS FACT does not change for patients with disabilities despite changes in sexual function which may arise as a result of their medical condition. It is the duty of physicians to ensure all patients with sexual dysfunction, including those with disabilities, are given the appropriate evaluation, diagnosis, and treatment options with the hope of ultimately providing them with a better quality of life.

Sexual History Taking

As with all patient interviews, it is important to maintain appropriate bedside manner, especially given the sensitive nature of this topic. A discussion on sexual dysfunction should be approached with tact and cultural competency. For structured guidance to beginning this discussion with patients, one may consider using the “ALLOW,” “PLISSIT,” or “BETTER” models.1,2 The initial evaluation begins with the chief complaint, which is the specific change in sexual function that is causing distress. Then, the line of questioning should progress to the history of present illness of the sexual dysfunction. This includes information regarding a typical sexual encounter, frequency, and time course of the problem—if it is partner-based or during masturbation, if it is situational or generalized, how it has influenced the patient's quality of life, and strategies or medications that have been tried previously (see Table 85–1).

Table 85–1Key Aspects of Obtaining a Useful Sexual History
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Table 85–1 Key Aspects of Obtaining a Useful Sexual History
Assure confidentiality and be nonjudgmental
Remind patients of why the information is clinically relevant
Be specific and use nonmedical terminology
Ask about sexually transmitted diseases as well as preventive and sexual risk behaviors, including type of sex, condom use, and number and types of partners
Make no assumptions based on patient characteristics
Explore situations that place individuals at increased risk (e.g., alcohol or substance use) and, together, develop a concrete risk-reduction plan
Use direct questions such as, “Do you have sex with men, women, or both?”; “How many partners have you had in the past 2 months, past 1 year”; and “How do you protect yourself from getting STDs?”

Reproduced with permission from Klausner JD. Chapter 31. The Sexual History. In: Klausner JD, Hook EW, III. eds. CURRENT Diagnosis & Treatment of Sexually Transmitted Diseases New York, NY: McGraw-Hill; 2007.

Alternative sources of information include the patient's sexual partner if the patient is agreeable and the Brief Sexual Symptom Checklist self-report tool that patients can fill out.1 Information regarding the patient's sexual history also provides appropriate context for the sexual dysfunction. It should include the age of the first sexual experience, types of sexual practices, frequency of masturbation, gender of partners, history of sexually transmitted diseases, safe sex practices, and method of birth control used. When obtaining the past medical history, it is important to directly ask about medical conditions that could ...

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