A review of the diagnostic practice of clinicians who assess patients with erectile and other sexual problems

Methods
Principal professional sexological organisations to which clinicians within the United Kingdom could subscribe were identified and a mailing database constructed. Recipients received up to 3 direct mail contacts (the initial one containing the questionnaire) and one telephone call to ensure completion of a questionnaire.

Results
814 completed questionnaires were returned. These were from 279 physicians and 535 non-physicians. Each respondent could mark one of five options (never, rarely, sometimes, often & very often).

                                Non-medic         Non-medic                        Physician         Physician        
                                NEVER             OFTEN/VERY OFTEN    NEVER          OFTEN/VERY OFTEN        
Sexual history             29 (5.4%)          402 (75.1%)                         4 (1.4%)       189 (67.7%)
Psychol. assessment   39 (7.3%)          319 (59.6%)                       22 (7.9%)       105 (37.6%)
Clinical examination  158 (29.5%)        120 (22.4%)                         8 (2.9%)       164 (58.8%)
Specialist clin. exam. 156 (29.2%)          82 (15.3%)                       10 (3.6%)       153 (54.8%)
Laboratory tests        177 (33.1%)          66 (12.3%)                       23 (8.2%)         89 (31.9%)
Rigiscan                    308 (57.6%)          17 (3.2%)                       146 (52.3%)       10 (3.6%)

Conclusions
Whilst most physicians will take a sexual history, some therapists will appear to rely more on the ‘therapeutic interview’ to elicit and understand sexual problems. Whilst a greater percentage of non-physicians take a psychological assessment fairly often, only a small number of both groups never do so. Physicians see the physical examinations as important whereas a third of other clinicians never attempt to get this area reviewed. Laboratory tests whilst still important to physicians are less used including specialist tests such as Rigiscan. Many of the problems which are being seen in clinical practice are not symptom specific indicating a requirement for a more integrated and inter-disciplinary provision of services where patients are presenting with sexual problems.

About the Author:

Kevan R. Wylie, MD FRCPsych DSM, works as Consultant in Sexual Medicine, Andrology & Psychiatry at Porterbrook Clinic, Nether Edge Hospital, Sheffield S11 9BF, and the Department of Urology, Royal Hallamshire Hospital, Sheffield S10 2JF, England.

Kevan Wylie qualified in medicine in Liverpool in 1985 and moved on to Leeds where he trained in psychiatry. He went on to postgraduate training in London achieving the Diploma in Therapy with Couples and Diploma in Sexual Medicine. He obtained his MD in couples sex therapy in 1999. Obtaining his first consultancy in Sheffield in 1995, he went on to a full time post in sexual medicine in June 1999. Dr. Wylie now works across two trusts as clinical lead for Porterbrook clinic and Consultant lead for andrology at the Royal Hallamshire Hospital. He is well supported by four full time nurses across both Trusts including Ruth Hallam Jones and Patricia Allen as well as fourteen staff who work part-time into the services from various clinical backgrounds including psychotherapists, counselors, other doctors and nurses and researchers.

The Porterbrook clinic, established in 1974, is one of the oldest NHS services and provides psychosexual and relationship psychotherapy as well as a comprehensive assessment and treatment service for all sexual dysfunctions. A service for gender dysphoria is provided for North Trent. The clinic also runs a MSc that Dr Wylie is Course Director to and provides training in human sexuality for undergraduate medical students at the University of Sheffield. The clinic is involved in many sexological research projects involving men, women and couples.

The andrology service at RHH offers a wide range of treatments for men with sexual problems within the Directorate of Urology. Together the two services receive around 1200 referrals a year for the wide range of sexual problems in women and men. There are close working relationships with gynaecology, family planning, endocrine and GUM services as well as primary care. Two leading campaign groups have praised Sheffield’s pioneering sexual problem services for men as a national example of best practice. The Impotence Association and Men’s Health Forum have joined forces to launch the Standing Up For Men Campaign to promote the overall sexual health and well being of men. Dr Wylie has recently become a trustee of the Impotence Association and sits on the Parliamentary Forum on transsexualism.

Dr Wylie sits on several national and international committees and advisory boards including BASRT, BSPOGA, BSSM, EFS, WAS, LCD/DCA, DoH & WHO as well as serving on scientific committees for several international meetings. He leads the psychosexual subgroup of the scientific committee of ESSM; has recently become the first ever UK General Secretary for the European Federation of Sexology and is a member of the 20 member strong advisory committee for the World Association for Sexology where he represents the UK regarding the diverse needs of sexual health, sex education and sexual medicine services. He serves as Editor-in-Chief of Sexual & Relationship Therapy that is now in its 18th year of publication and will be President of the EFS Congress in Brighton in May 2004.

Address:
Kevan R Wylie, MD
Porterbrook Clinic
75 Osborne Road
Nether Edge
SHEFFIELD. S1 9BF. UK
Tel. +44 (0) 114 271 8674
www.porterbrookclinic.org.uk
eMail: k.r.wylie@sheffield.ac.uk