Sexual Problems

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.

Female Sexual Problems

• Female Orgasmic Disorder (FOD)
• Female Sexual Interest/Arousal Disorder (FSID/FSAD)
• Genito-pelvic Pain/Penetration Disorder (GPPPD)
  • this includes vaginismus, vulvodynia and superficial dyspareunia

BUT 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.

Male Sexual Problems

• 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).

Who not to refer:

Erectile Dysfunction with a physical cause:

• The ED clinic referral protocol 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‘
• Investigation and medical/surgical treatment of erectile dysfunction with a physical cause is provided by a Specialist ED Clinic in the Urology department at the Western General Hospital.

Gender Identity concerns

These are dealt with in the Gender Identity Clinic 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.

Sexual problems which are primarily caused by untreated mental health issues

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

• This is seen as a compulsive/addictive disorder rather than a sexual problem 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:
  https://www.lothiansexualhealth.scot/specialist-services/psychosexual-therapy/sexual-addiction

How to refer:

• Refer via SCI Gateway to: Chalmers Sexual Health Centre à Sexual and Reproductive Health & GU Medicine à 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 to avoid penetrative sex if painful or causing anxiety and focus on non-penetrative mutual pleasure though sensual touch/sensate focus.

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 psychosocial website for information and self-help resources: https://www.lothiansexualhealth.scot/specialist-services/psychosexual-therapy  

For advice about a patient, including whether to refer, PROFESSIONALS ONLY can contact the clinical advice line at chalmers.clinicaladv@nhslothian.scot.nhs.uk. 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.

Information on non-NHS organisations providing psychosexual therapy and relationship therapy can be found here:

https://www.lothiansexualhealth.scot/specialist-services/psychosexual-therapy/useful-books

Websites, links and self-help books that other patients have found useful can be found at:

https://www.lothiansexualhealth.scot/specialist-services/psychosexual-therapy/useful-links-and-books

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

College of Sexual and Relationship Therapists (COSRT) – the COSRT website 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  – 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.