Approach to screening for sexual difficulties

This topic is relevant to people of all gender identities and sexual orientations. The gender identity of the person seeking healthcare may differ from that presumed for them at birth, and healthcare providers are encouraged to use a sensitive approach that avoids assumptions about gender identity, sexual orientation or sexual practices.

Sexual difficulties are very common and include:

Sexual symptoms may be both distressing and markers of concurrent problems with physical or mental health. Various barriers may prevent people raising the topic with their GP, or vice versa. People may not be aware of treatment options, or may fear issues such as costs of treatment, the possibility of being judged or the risk that they or the clinician would feel awkward. Clinicians may not ask about sexual symptoms for a range of reasons, including lack of time, training, resources or assumptions, for example, that an individual is too old or ill to have sexual concerns.

Consider screening for sexual symptoms as part of regular consultations. The goals of an initial discussion include:

  • understanding and assessing any sexual concerns
  • validating the individual’s experience
  • offering information
  • considering indications for further assessment and interventions.

Ways to start a conversation include offering an opportunity to discuss sexual concerns framed as part of a general review of physical and mental health. Acknowledging the following may help to encourage a conversation about sexual concerns:

  • changes in sexuality (as noted above) are common and many people have questions, but are unsure about asking
  • a conversation may be enough to alleviate worry about sexual symptoms, but it can be an introduction to other options
  • if now is not the time, a conversation can be had later with any staff of their choice who have appropriate skills
  • written patient information (see below) is available; some people may prefer to read this as a first step before deciding whether to discuss their concerns.

For more advice on broaching sexual issues in consultations, including sample screening questions, see Australian Family Physician. For advice on language that is inclusive of trans and gender diverse individuals, see the Australian Professional Association for Trans Health website and the TransHub website. For guidance on healthcare issues for individuals of diverse sexual orientation, see A guide to sensitive care for lesbian-gay-and bisexual people attending general practice at the Rainbow Health Victoria website.

After initial discussion, the decision on whether to refer or to undertake further assessment (if indicated) or management of sexual symptoms depends on the clinician’s level of expertise. Management may involve any of the following:

  • The provision of information—education (which may also be provided by nurses, counsellors, specialist physiotherapists and sexual health physicians) can include verbal or written material regarding normal sexual function, contributing factors to sexual difficulties and management options. Many people (particularly young individuals) have unrealistic expectations of sexual experiences, which contribute to distress.
  • Specific therapeutic suggestions (eg altering medications or suggesting referrals).
  • More in-depth therapy, such as some forms of counselling (including behavioural treatment). Consider referral to an accredited therapist with a specialist interest in sexual health practice, such as a sexual medicine specialist, sexologist, general practitioner, nurse, psychologist, other sexual health counsellor or sexual health physician. The Society of Australian Sexologists and the Australian Psychological Society set national accreditation standards for quality and safety of practice and list accredited members.

See History taking for a person with sexual difficulties for a guide to assessing sexual concerns.

For patient information, see: