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1577particularly those with erectile impotence, is similar to that reported by Milne in a comparable clinic. There is no evidence that this is associated with a longer duration of the problem in the couples with a male presenter, and this raises the possibility that different aetiological factors, related in some way to aging, are operating among men. Categorisation on the basis of the type of sexual dysfunction, though traditional, is probably of limited value as it may exclude patient characteristics, such as the degree of performance anxiety or the amount of resentment in the relationship, which are more relevant to assessing the response to treatment. The high proportion of people rejecting or not being considered suitable for counselling indicates the complex nature of and the high degree of ambivalence associated with many of these interpersonal problems. Any treatment which requires a high degree of commitment from both partners should be expected to meet with a high rejection rate in such a clinic population.Substantial benefits for two-thirds of those receiving treatment is an encouraging outcome, given that much of the treatment was given by therapists using the treatment method for the first or second time. With greater therapeutic experience this outcome should be improved further. The treatment approach has also proved to be both readily accepted by most therapists and easily taught and supervised. While the behavioural component is relatively straightforward, however, the psychotherapeutic element does require therapist skill and will be more important in those cases in which complex interpersonal or attitudinal factors are operating.The negative association between the number of sessions and outcome suggests that those who do well with this method do so with relatively few sessions. Those who drop out of treatment usually do so after three or four sessions. This stage of treatment is generally a good time to appraise the likely outcome, and in those cases in which the prognosis is uncertain a limited contract of three or four sessions can be made in the first instance.We hope that our experience with this clinic will encourage health authorities in other areas to establish such a service, which would demand only limited resources and yet help to solve problems that have widespread and long-term repercussions on family health.We thank Judy Bancroft, Tony Carney, Keith Hawton, and Anne Young for their help in the clinic.