Clinical Practice Guidelines for Management of Sexual Dysfunction

Participants of the Expert group on CPG for management of sexual dysfunction Murgesh Vaishnav, G Prasad Rao, Neelanjana Paul, Mukesh P Jagiwala, Roop Sidana, M S Bhatia INTRODUCTION Sexual functioning is a complex bio-psycho-social process, coordinated by the neurological, vascular and endocrine systems. In addition to the biological factors, the psychosocial factors like societal and religious beliefs, health status, personal experience, ethnicity and socio-demographic conditions, and psychological status of the person/couple play an important role in adequate sexual functioning of a person. In addition, sexual activity incorporates interpersonal relationships, each partner bringing unique attitudes, needs and responses into the coupling. A breakdown in any of these areas may lead to sexual dysfunction. Prevalence of sexual dysfunction in general population is very high. It is suggested that about 43% of women and 31% of men have one or other kind of sexual dysfunction. Among men, premature ejaculation is the most common male sexual dysfunction. There is lack of consensus with regards to the most common sexual dysfunction in women with some studies reporting hypoactive sexual desire disorder to be the most common entity, followed by orgasmic and arousal disorders; whereas other studies suggest that difficulty achieving orgasm and vaginal dryness to be the most common type of sexual dysfunction in women. Problems of sexual dysfunction may be lifelong or acquired, general or situational. Although sexual problems are highly prevalent, these are frequently under-recognized and under-diagnosed in clinical practice. It is also noted that clinicians also have lack of understanding about the approach for identification and evaluation of sexual problem. It is often recommended that the treating psychiatrists and collaborating specialists need to possess broad knowledge and appropriate attitude towards human sexuality. The essential concepts underlying the management of sexual problems are adoption of a patient-centered framework for evaluation and treatment. Principles of evidence-based medicine may be followed in both men and women in diagnostic and treatment planning and adoption of common management approaches for sexual dysfunction. The purpose of these guidelines is to present a framework for the evaluation, treatment, and follow-up of the patient/couple, who presents with sexual dysfunction. We hope that these guidelines would help in facilitating proper management of patients presenting with various types of sexual dysfunction. These guidelines are to be read along with the earlier version of Indian Psychiatric Society Guidelines. CLASSIFICATION OF SEXUAL DISORDERS Compared to DSM-IVTR, DSM-5 has fewer categories for describing sexual dysfunction and has provided gender-specific sexual dysfunctions (Table-1). 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