Management of sexual disorders

Sexual disorders comprise (a) disorders of function in which sexual functioning is disturbed leading to problems during sexual intercourse, (b) disorders of orientation whereby a non heterosexual partner or object is sought, and (c) other disorders involving aberrant psychosexual behaviour. In managing such problems a thorough psychosexual assessment is required in order to ascertain the exact nature of the problem and what the precipitating, predisposing and prolonging factors are. In disorders of orientation and disorders involving aberrant sexual behaviours, the developmental history and early childhood relationships must be looked into carefully. Laboratory investigations are usually indicated in erectile dysfunction as up to 80% would have an organic aetiology--vascular, neurological and endocrine disorders have to be ruled out. Treatment of the various conditions involves general sexual counselling, behaviour therapy including stress management, psychotherapy, marital therapy and drug therapy as indicated. However, in erectile dysfunction, drug treatment (including intracavernosal injections), mechanical aids, or surgery may be indicated; and in transsexualism--for those who are unable to revert to accepting their natural status--a sex reassignment operation is the treatment of choice.