PrognosisItis difficultto generalize,butmost patients seen for adviceaboutsexualproblemsimprovetosomeextent.The advent of sildenafil wilcertainlyhave improvedoutcomesoverall
Prognosis It is difficult to generalize, but most patients seen for advice about sexual problems improve to some extent. The advent of sildenafil will certainly have improved outcomes overall
Sexual deviationsMostvariantsof sexual orientationandbehaviour,sometimescalled“paraphilias'or“alternative sexualpractices",arenolongerclassedaspsychiatricdisorders,andmoreliberalattitudes in society duringrecent years have reduced thefrequencyof psychiatricinvolvementwiththem.Howeversometimesthese variants are associatedwith psychiatricdisorder,socialmaladjustment,ortransgressions ofthelaw
Sexual deviations Most variants of sexual orientation and behaviour, sometimes called ‘paraphilias’or ‘alternative sexual practices’, are no longer classed as psychiatric disorders, and more liberal attitudes in society during recent years have reduced the frequency of psychiatric involvement with them. However, sometimes these variants are associated with psychiatric disorder, social maladjustment, or transgressions of the law
Sexual deviationsPsychiatric treatment is only indicated in carefullyselectedcases.Whena sexual deviation leads tothepatient'sdevelopingsecondarypsychiatricproblems,suchasdepressionorsubstancemisuse,psychiatricassessmentmaybeappropriate.However,the boundaries have to be clear.The patientmust be clearly told thathe retains responsibilityfor hisbehaviour.In deviations whichlead to conflict withthelaw,suchaspaedophilia,mentalhealth services have tobe extremelycautious about involvement, in case they are blamed-probablywrongly,butmudsticks-ifthesubjectreoffends
Sexual deviations Psychiatric treatment is only indicated in carefully selected cases. When a sexual deviation leads to the patient’s developing secondary psychiatric problems, such as depression or substance misuse, psychiatric assessment may be appropriate. However, the boundaries have to be clear. The patient must be clearly told that he retains responsibility for his behaviour. In deviations which lead to conflict with the law, such as paedophilia, mental health services have to be extremely cautious about involvement, in case they are blamed – probably wrongly, but mud sticks – if the subject reoffends
DyspareuniaDyspareuniaispainonintercourse.Itmayresultfromimpairedlubricationwithvaginal secretions (duetoanxietyorinadeguatearousal)orfrom physical scarring(e.g.afterchildbirth).PainonpenetrationmaybeduetopelvicpathologyUterusBladderSpeculumCervixRectum
Dyspareunia Dyspareunia is pain on intercourse. It may result from impaired lubrication with vaginal secretions (due to anxiety or inadequate arousal) or from physical scarring (e.g. after childbirth). Pain on penetration may be due to pelvic pathology. Back
DyspareuniaWhendyspareunia issecondarytopsychologicalfactors,sexual therapytechniques canbeused(seebelow)
Dyspareunia When dyspareunia is secondary to psychological factors, sexual therapy techniques can be used (see below)