Diagnostic Approaches to Sexuality in the Medically Ill

Abstract

The diagnosis of a sexual dysfunction in an individual with a medical disorder has gained attention since Masters and Johnson delineated a normal sexual response cycle. Early psychoanalytic investigators emphasized the ubiquitous nature of sexual fears, fantasies, and frustrations associated with both normal and abnormal psychosexual development. Treatment for sexual dysfunctions was considered within the context of neurotic illness and/or characterologic deficits. The development of current behavioral treatment methods utilizing both learning and psychodynamic principles are symptom focused and have achieved reasonably good results. Concurrently, development of specific medical and surgical procedures, such as the penile prosthesis, has restored sexual functioning in men with organic defects. Contemporary psychiatric competence includes the ability to assess sexual disorders both in the physically healthy and medically ill. This chapter will present an approach to the medically ill patient with a sexual dysfunction. By reviewing present diagnostic nomenclature of sexual dysfunctions in the healthy individual as well as reviewing the clinical assessment of sexual dysfunctions in healthy patients and those physically ill, the reader will learn a systematic approach to evaluating such problems.