Gynecological conditions are frequently associated with sexual difficulties which are often underdiagnosed. Patients feel that sexual problems are not important enough to be mentioned to their physicians and physicians may feel uncomfortable and sometimes incompetent. To facilitate access for patients and physicians we developed a tool for assessment and discussion of sexual problems for residents in gynecology. Methods: Based on our experience as a liaison-consultation sexological division of the university hospital of Basel we analized the sexological diagnostic workup performed with the following group of female patients: Family planning consultation, around menopause, women with benign gynecological conditions, with incontinence; Oncological patients ( mammary , genital carcinoma),. We extracted the commonly used steps in the workup to construct a tool with easy to remember elements which would help the physician to evaluate the patients‘ sexual problems and plan for referral or therapy. We trained 20 residents residents and evaluated their self rated competence before and after the training. Results: We could differentiate seven steps of sexual history taking: Raising the subject of sexuality by indirect or direct invitation to the patient; Active listening to the narrative; Asking for a typical sequence of the sexual encounter; Establishing a 6 field pathogenetic model of the sexual problem: 3 levels (biological, individual psychological, interactional-social) 3 dimension (Predisposing, Precipitating, Maintaining); Round table (Communicating the diagnosis, defining resources and therapeutic objectives) ; Brainstorming about therapeutic options; Shared decision making. Resident training with this structured tool resulted in an increase in self rated competence and efficiency in managing sexual problems. Conclusion: Sexual problems are frequent in gynecology. We have developed a tool to help physicians to evaluate sexual problems of their female patients in order to facilitate access to recognition and possible treatment.
Conflict of Interest: None disclosed
Financial Support/Funding: None disclosed
Recorded: Sydney, Australia, April 2007
more about this speaker
