Sexual counseling. What the busy physician can, and cannot, do

Patients with sexual problems often seek help first from their family physician. Before referring these patients, the physician should determine the kind of dysfunction present and whether it might successfully be treated in the general office setting. Secondary impotence can often be overcome by simple reassurance or by a program of frequent sexual foreplay and avoidance of actual intercourse. A stop-start method of reconditioning has had some success in the treatment of premature ejaculation. Anorgasmia is a commonly reported female complaint. If caused by inadequate foreplay, counseling and interpersonal discussion should lead to successful resolution. There is some evidence that anorgasmia in some cases may result from clitoral adhesion or underdevelopment of the pubococcygeus muscle. Both conditions may be simply remedied.