Sexual dysfunction: A systematic review of South African research

Abstract

Results of this survey indicated that psychiatrists considered the sexual dysfunction (F52) disorders of the ICD-10 as having low ease of use and poor goodness of fit, suggesting the need for considerable revision in the ICD-11 to improve clinical utility.Background. The World Health Organization is in the process of revising the International Classification of Diseases and Related Health Problems (ICD). Sexual dysfunction disorders (F52) have been identified as having poor clinical utility. South Africa (SA) has been selected as one of five low-and middle-income countries in which studies will be developed to assess the clinical utility of the proposed ICD-11 revisions for sexual dysfunction disorders. Objective. To identify scientific research generated in SA on sexual dysfunction disorders to guide these studies. Methods. A systematic review of SA research on sexual dysfunction disorders published in peer-reviewed journals. Results. Despite the high prevalence of ejaculatory and erectile dysfunctions, only five SA articles have addressed male sexual dysfunction since 1970. Lack of sexual interest and inability to reach orgasm are the most commonly reported complaints for women, yet only four SA articles have been published on the topic of female sexual dysfunction. Diabetes mellitus, cardiovascular disease, genitourinary disease and psychiatric or psychological disorders are common comorbid conditions associated with sexual dysfunction in both sexes, but only nine articles address sexual dysfunction as the main topic with respect to comorbid conditions. Conclusion. Despite growing awareness of the importance of sexual health, SA-based scientific research on sexual dysfunction is limited. Further work is needed to inform recommendations for ICD-11 revisions drawn from the SA context.

Communicating with older adults about sexual issues: How are these issues handled by physicians with and without training in human sexuality?

“…These physicians cited a number of barriers to such discussions, among them lack of time, heavy workload, a sense that such matters were outside their area of expertise and a feeling that these were intimate matters that should not be discussed (Fileborn et al, 2017;Gott, Hinchliff, & Galena, 2004;Haesler et al, 2016;Levkovich, Gewirtz-Meydan, Karkabi, & Ayalon, 2018. These findings are in line with those of previous studies indicating that medical personnel lack self-confidence in this area and feel uncomfortable discussing these topics and that family physicians feel more confident about providing diagnoses and treatment in their own areas of expertise (Campbell, Stein&, 2014;Gandaglia et al, 2014;Gilmer, Meyer, Davidson, & Koziol-McLain, 2010;Hughes & Lewison, 2015).…”

Views of family physicians on heterosexual sexual function in older adults

“…Our study is supported by similar studies in which physicians preferred to discuss sexual dysfunction mainly in combination with old-age risk factors, e.g., hypertension and diabetes, in comparison with patients without risk factors [ 62 ]. Coronary heart disease, psychiatric disorders and psychological disorders were found to be disorders in which physicians turn to patients for evaluation of sexual function [ 63 , 64 ]. It is possible that when the discourse takes place around the focal point of the physician’s expertise, i.e., the physiological field, the family physician feels more confident in making a diagnosis and providing a satisfactory solution.…”

“…Consistently, according to the physicians, most patients with sexual dysfunction are men. Studies show that the impotence rate varies according to age, beginning at 2% for men under 40 and going up to 71% for men over the age of 70 [ 64 , 66 ]. The diagnostic process, which is biological, examines the patient’s symptoms, prevalence of the disorder, background illnesses, medication taken by the patient, and sometimes a physiological evaluation.…”

Sexual health in the South African context

“…These limited educational opportunities are mirrored in the limited current, original research in the area of sexual health in South Africa. [4] This gap in training and continued professional development in the area of sexual health has implications for clinician confidence when assessing and treating sexual problems in patients in general and in sexual minority groups such as LGBTI patients in particular.…”