Sexual counseling for the nontherapist

Sexual health is a part of total health. Sexual problems can cause marital dissolution and emotional impoverishment. The physician is seen as a wise authority figure often and one who can provide sexual guidance and counsel. To be an effective counselor, an obstetrician/gynecologist must acquire sexual knowledge, comfort, and counseling skills. A sexual history is a recommended routine--as part of the new workup, when management of organic problems and treatment (mastectomy, hysterectomy, radical vulvectomy) necessitate inquiry into the patient's sexual practices and sexual value system, and when the patient presents with suspected "functional" or obscure complaints (hyperventilation, palpitations, chronic pelvic pain, recurrent vaginal discharge without obvious pathogens, chronic concerns that everything is all right "down there", cancerphobia). The sexual problem history is readily applicable, especially when a patient presents with an explicit sexual concern. The PLISSIT method is a paradigm that can be utilized effectively with usual referral for intensive therapy (sex therapy) if sexual counseling is ineffectual. The obstetrician/gynecologist can play an important role in facilitating healthful sexual changes in women and couples, enhancing intimacy, and enriching the marital bond.