Evaluation and Treatment of Sexual Disorders Due to Medical Conditions

Abstract

A major problem facing practicing physicians is the continued prevalence of sexual disorders due to medical conditions. There is a growing awareness surrounding their effect on patient well-being and life satisfaction. To date, our understanding of the impact that various medical conditions can have on optimal sexual function is a complex and difficult clinical phenomenon, which often has many competing etiological considerations and treatment options. Accordingly, there is growing concern pertaining to both the evaluation of, and treatment for, sexual disorders that are secondary to a variety of medical conditions. Previously, the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) characterized sexual disorders due to medical conditions as psychiatric diagnoses. However, recent changes in the classification system of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) have established new criteria for sexual disorders. Specifically, new guidelines require disorders of sexual dysfunction that are attributable to a medical condition to be viewed as non-psychiatric diagnoses. As such, the initial evaluation of presenting sexual disorders requires ruling out any comorbid medical condition(s) that may affect sexual function. Therefore, it is important for physicians to have a deep appreciation for and robust understanding of the innumerable medical conditions that can affect optimal sexual function. In this chapter, we discuss epidemiology, etiology, pathophysiology, diagnostic criteria, and best evidence-based practice and approaches to the diagnosis of sexual disorders due to medical conditions. We further provide a review of diagnostic tests frequently used by physicians to aid in diagnosis and monitoring of treatment outcomes for sexual disorders. We conclude by highlighting key findings from studies focused on the treatment of sexual disorders by reviewing evidence-based approaches to biological treatments (i.e., medications, devices), psychosocial treatments, and prognosis of sexual disorders.