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MCC Examination Objectives Medical expertSexual dysfunctions and disorders

Sexual dysfunctions and disorders

Version: April 2019
Legacy ID: 94

Rationale

Sexual dysfunction includes clinically significant disturbances in the ability to respond sexually or to experience sexual pleasure. Some sexual behaviours may cause harm.

Causal Conditions

(list not exhaustive)

  1. Erectile or orgasmic dysfunctions
    1. Psychological or emotional (e.g., depression, abuse)
    2. Neurologic dysfunction (e.g., spinal cord injury)
    3. Vascular insufficiency (e.g., diabetes)
    4. Drug adverse effects (e.g., β-blockers)
    5. Aging
  2. Genito-pelvic pain or penetration issues (dyspareunia)
    1. Trauma (e.g., episiotomy)
    2. Hormonal (e.g., vulvovaginal atrophy postmenopause)
    3. Other pelvic pathology (e.g., endometriosis, pelvic inflammatory disease)
  3. Substance- or medication-induced sexual dysfunction (e.g., alcohol, sedatives)
  4. Gender dysphoria
  5. Sexual disorders
    1. Paraphilic disorders (e.g., sexual sadism, pedophilia, fetishes causing harm)
    2. Sexual addiction
    3. Arousal disorders
    4. Anorgasmia

Key Objectives

Given a patient with sexual dysfunction or disorder, the candidate will address the issues and offer appropriate support and management measures. Because these issues can be emotional, physicians should strive to approach them in an unbiased and nonjudgmental way, with respect for the patient’s wishes and values.

Enabling Objectives

Given a patient with sexual issues, the candidate will

  1. list and interpret critical clinical findings, including those derived from an appropriate history, including the patient’s physical and sexual development and their comfort with their sexuality, and a physical examination, where appropriate, to
    1. identify treatable causes (e.g., atrophic vaginitis, diabetes, antidepressant medications);
    2. differentiate between sexual dysfunction versus sexual activity causing harm;
  2. list and interpret critical investigations as required to identify underlying causes;
  3. construct an effective initial management plan for underlying issues:
    1. construct a relevant safety plan where appropriate;
    2. prescribe medications where appropriate (e.g., sildenafil, estrogen);
    3. determine whether the patient requires specialized care;
    4. engage psychosocial support where appropriate;
    5. counsel and educate.