The Psychosexual Therapy Service for Lothian is based within the Chalmers Centre and provides psychosexual counselling for patients who fulfil the DSM 5 diagnostic criteria for sexual dysfunctions (see referral guidelines below).
Please note this is a psychological intervention for patients and their partners (if applicable).
Appointments are available in person or via telephone or NearMe.
The service is staffed by a team of therapists with specialist qualifications in psychosexual therapy. It provides psychological therapy which includes cognitive behavioural interventions. Patients may be expected to attend a series of appointments at weekly or fortnightly intervals for 2-6 months; although some may only be seen once or twice depending on the complexity of their problem.
For advice about a patient, including whether to refer, PROFESSIONALS ONLY can contact the clinical advice line at chalmers.clinicaladv@nhs.scot.
Please see the Primary Care Management page for approaches to be explored prior to referral.
Who to refer:
Patients who meet the criteria of having a sexual problem (see below) and which is likely to be helped by psychosexual counselling. Almost everyone has some difficulty with their sex life at some point usually attributable to relationship issues, life events or illness. In recognition of this the DSM 5 (Diagnostic and Statistical Manual for Mental Disorders, 5th edition (2013)published by the American Psychiatric Association) definition of a sexual problem requires that it:
- occurs 75%-100% of the time,
- is present for a minimum of 6 months,
- is deemed to have caused significant distress to the individual concerned and
- cannot be better explained as another physical or mental illness, a consequence of severe relationship distress or other significant stressors.
The Sexual Dysfunctions
- Female Orgasmic Disorder (FOD)
- Female Sexual Interest/Arousal Disorder (FSIAD)
- Genito-pelvic Pain/Penetration Disorder (GPPPD)
- this includes vaginismus, vulvodynia and superficial dyspareunia
- Erectile Dysfunction (ED) with a psychological cause:
- If the patient experiences severe distress due to ED, then they may be eligible for NHS prescription of treatments (see below for details)
- Delayed Ejaculation (DE)
- Premature (early) Ejaculation (PE)
- Male Hypoactive Sexual Desire Disorder (MHSDD).
PLEASE NOTE – gynaecological / infective causes should be excluded and deep dyspareunia investigated before referral to psychosexual services. Please see the Lothian guidance on the gynaecological investigation of chronic pelvic pain opens a new window.
Who not to refer:
Erectile Dysfunction with a physical cause:
- The ED clinic referral protocol opens a new window suggests men with ED have a trial of a 5-Phosphodiesterase Inhibitor e.g. Sildenafil/Tadalafil
- Men who experience severe distress due to ED will be eligible for NHS prescription of medications by application for an ‘Erectile Dysfunction Severe Distress Assessment’ opens a new window
- Investigation and medical/surgical treatment of erectile dysfunction with a physical cause is provided by a Specialist ED Clinic opens a new window in the Urology department at the Western General Hospital.
Gender Identity concerns
- These are dealt with in the Gender Identity service opens a new window at Chalmers.
Sexual problems as a result of untreated trauma
- Such cases should be referred to an appropriate trauma service for treatment before any psychosexual therapy can be undertaken e.g. please see Trauma and PTSD opens a new window.
Sexual problems which are primarily caused by untreated mental health issues opens a new window
- Patients with depression, anxiety, Post Traumatic Stress Disorder (PTSD) or other major psychiatric diagnoses are best served by referral to the appropriate service for treatment before referral for psychosexual therapy.
Past Sexual Abuse or Sexual Trauma with no sexual problem
- Refer or signpost to appropriate trauma or third sector support.
Sexual Addiction / Compulsive Sexual Behaviours
- This is seen as a compulsive disorder rather than a sexual problem (ICD 11) and is not managed at the Chalmers clinic. The psychosexual therapy clinic does not take referrals for sex or pornography addiction.
- Information which might be helpful is here:
How to refer:
Refer via SCI Gateway to: Chalmers Sexual Health Centre > Psychosexual Therapy
By mail to:
Psychosexual Therapy Clinic
Chalmers Centre
2a Chalmers Street
Edinburgh EH3 9ES.
Before referral please:
- Discuss / allay concerns of a physical cause and investigate if necessary. The psychosexual therapy service is staffed by non-medical counsellors who therefore cannot examine, investigate or prescribe.
- Encourage the sharing of their concerns with their partner.
- Advise patients to avoid penetrative sex if painful or causing anxiety and focus on non-penetrative mutual pleasure though sensual touch/sensate focus.
- Consider whether a referral to the following would be appropriate:
- Chronic Pelvic Pain
- Pelvic Pain & PID
- Fertility and Reproductive Endocrinology
- Vulval Disorders
- Musculoskeletal (physiotherapy)
- Gynaecology
- Urology.
If referring, please:
- Discuss partner factors and that the partner may be asked to attend too (but no partner / lack of partner engagement is not a reason to withhold referral)
- Ensure patient knows they are being referred for a psychological / CBT based therapy
- Ensure patient is aware of potential long wait (20+ months) and possibly discuss self-referral to other sectors – please see below for website information
- Direct patient to the Chalmers psychosexual website opens a new window for information and self-help resources.
For advice about a patient, including whether to refer, PROFESSIONALS ONLY can contact the clinical advice line at chalmers.clinicaladv@nhs.scot opens a new window. If the senior member of staff dealing with this advice line is unable to answer your questions, then the e-mail will be passed to the clinical lead for psychosexual therapy.
Lothian Sexual Health Website – the Psychosexual Therapy section (in Specialist Services section) provides information about sexual problems, psychosexual therapy and the psychosexual clinic service with resources including non-NHS services, websites, links and self-help books for clinicians and patients at: https://www.lothiansexualhealth.scot/specialist-services/psychosexual-therapy opens a new window
College of Sexual and Relationship Therapists (COSRT) – the COSRT website opens a new window provides useful information for the public about a number of topics including relationship difficulties, common sexual problems, sexual gender identity, sex and disability and sex after a diagnosis of cancer.
The website also provides contact details for COSRT qualified and accredited psychosexual therapists and links to related websites and resources which might be helpful.
Sexual Wellbeing website for patients
https://sexualwellbeingforall.wordpress.com opens a new window – this site provides information and resources for people who are experiencing a variety of sexual difficulties and problems, including lists of podcast, self-help guides and books. It includes a trans section too.
Links to other websites are provided for convenience: NHS Lothian is not responsible for the information contained in these websites.
