Psychiatrists' role in teaching human sexuality to other medical specialties.

OBJECTIVES: This article addresses the potential role for psychiatrists in teaching sexuality to other medical disciplines. METHODS: The authors searched PsycNet and PubMed/MEDLINE for pertinent articles and studies from the period between 1990 and 2009 using the terms human sexuality; teaching human sexuality; teaching methods; education and treatment in human sexuality; and medical practice. The senior author also drew on 20 years of experience teaching other medical specialists. RESULTS: Although few studies exist, the authors identified areas in which a psychiatrist might have particular teaching skills to impart: taking a sexual history; patient and physician communication; the partner's role; effects of depression on sexual health; sexual trauma and abuse; physical, intellectual, and developmental disabilities; sexual boundary issues; and working with gay, lesbian, bisexual, and transgendered persons. CONCLUSION: Psychiatrists deal with complex emotional issues and are alert to subtle emotional cues. They gather detailed histories, screen thoroughly for psychopathology, and consider the importance of interpersonal relationships. These attributes are potentially valuable when psychiatrists assist other specialists in addressing patients' sexual health. Psychiatrists with additional training in sexuality may be particularly adept in educating colleagues from other specialties.

Through the eyes of women: the partners' perspective on tadalafil.

OBJECTIVES: To evaluate patient and female partner responses on the efficacy of, and overall satisfaction with, tadalafil to treat erectile dysfunction using sexual encounter profile (SEP) diaries. METHODS: Data were pooled from four double-blind, placebo-controlled, 12-week trials that included 746 couples. Patients were randomized to placebo or tadalafil 10 or 20 mg. Efficacy was evaluated by the mean per-patient/per-partner percentage of "yes" responses to patient SEP questions 1, 2, and 5 and partner SEP questions 1 to 3 (erection achievement, penetration, and overall satisfaction with the sexual experience, respectively) for tadalafil versus placebo. For each SEP question, the number of postbaseline intercourse attempts when each couple agreed on the outcome was tabulated and divided by the total number of postbaseline attempts to calculate the mean percentage of agreement by couple. The overall satisfaction with successful postbaseline intercourse attempts was determined. RESULTS: Tadalafil significantly improved the responses for the patient and partner-evaluated SEP questions (P <0.001, both doses versus placebo). Partners tended to report greater overall satisfaction than patients at baseline and postbaseline. The mean percentage of agreement by couple was approximately 98% for erection achievement and penetration and 85% for overall satisfaction. For successful intercourse attempts, patients and partners treated with tadalafil reported more overall satisfaction than those treated with placebo (P <0.05, tadalafil versus placebo comparisons). CONCLUSIONS: Partners reported significantly improved overall sexual satisfaction and corroborated the man's report of improved erections and penetration ability with tadalafil 10 mg or 20 mg. Men reported improved erection achievement, penetration, and overall satisfaction with the sexual experience after taking tadalafil.

Diabetes and female sexual dysfunction: moving beyond "benign neglect".

Female sexual response is a complex, nonlinear progression from desire to arousal and orgasm. Diabetes may affect all these, but it particularly affects arousal with decreased genital sensation and lubrication. Vaginal dryness and infections may lead to dyspareunia. Predictors of sexual dysfunction in women include depression. Neither age, duration of diabetes, glycemic control, nor complications predict sexual dysfunction in women as they do in men. Objective measures of decreased genital sensation or lubrication do not correlate with a subjective sense of female sexual arousal disorder. Low androgens and possibly estrogens may be etiologic, as may numerous medications used by patients with diabetes. Practitioners should recognize the high prevalence of female sexual dysfunction (up to 50%) and potential increase, in tandem with that of diabetes. In the absence of definitive treatment evidence, psychological counseling, improvised vaginal lubricants, and low doses of estrogens or androgens have been used to relieve the personal distress of female sexual dysfunction.

Restoration of couple's intimacy and relationship vital to reestablishing erectile function.

The new modes of pharmacologic therapy give health care practitioners an unprecedented opportunity to treat patients with erectile dysfunction (ED), an undiagnosed and underreported condition. Yet even with a portfolio of effective treatment modalities, such as phosphodiesterase type 5 (PDE5) inhibitors, nonpharmacologic interventions should be considered as means to support and augment the effects of these agents. Of equal value--and necessity--is the involvement of the man's partner in both the assessment and treatment processes. Because men see the primary care physician's office as a natural and expected place in which to address issues of sexual health, those healthcare professionals who are prepared to initiate discussion of ED can offer patients and their partners the possibility of effective and enduring treatment success and the restoration of a satisfying relationship.