Clinical Manual of Sexual Disorders

Clinical Manual of Sexual Disorders

edited by Richard Balon, MD, and Robert Segraves, MD, PhD. American Psychiatric Publishing Inc, Arlington, VA, 2009, 443 pages, $59.00 (paper).

Many physicians are uncomfortable talking about sex with their patients. Many psychiatrists are poorly trained in evaluating and treating the sexual problems of their patients. Balon and Segraves, both psychiatrists well versed in sexual disorders, contend that psychiatrists have largely abandoned sexuality in their assessment and treatment of patients with mental disorders. This book serves as a fine primer and antidote to this suggested professional malaise and oversight. The book is written clearly and is intended for clinicians, not researchers. The editors and the assembled group of international authors illustrate how sexual dysfunction fits into the complex understanding of psychological, medical, and pharmacologic contributors to the often ignored sexual problems that face our patients. Sexuality is important for patients, so it should be de facto important for psychiatrists to appreciate. The authors reasonably contend that sexual dysfunction is often multidetermined, requiring in-depth interviewing to understand partner relationships, as well as physiologic, drug, and psychological contributors. Anyone blissfully ignoring these aspects of their patients’ lives will be enriched by this manual, particularly because it focuses on what is known far more than on theoretical constructs.

The book is clinically focused and divided in 3 parts. Part 1 is titled Assessment, Comorbidity, and Medication Effects. This section gives a fine background in the evaluation of problems, ranging from simple problems to more complex ones, highlighting how sexual problems may manifest as psychological problems, may be the result of psychological problems, or may interact with each other in complex ways. The complexity is amplified and examined with realistic, useful scenarios, including evaluating patients in the context of their marriage and chronic medical conditions. The section on medication affecting sexual functioning is general, without getting too detailed regarding study findings. It describes the possible strategies to combat drug-induced sexual problems while emphasizing the importance of sexual assessment before starting psychopharmacologic treatment.

Part 2 details management of sexual disorders. This section includes 8 common DSM-IV-defined sexual disorders. Each chapter may be read independently of the first section if practitioners feel comfortable with assessment, particularly because assessment of each disorder is described within the individual chapters. The chapters identify key elements of the diagnoses as well as interviewing suggestions to tease out the diagnosis from overlapping mental and medical conditions. Psychological as well as medical treatments are discussed in practical ways. The section on male erectile disorders is particularly clear and useful. Each chapter ends in a 1-page section titled "Key Points." These provide an excellent summary of the chapter and reinforce the chapter’s aims.

The final section of the book addresses age-related sexual issues, covering the delicate inquiries into adolescent sexual concerns and sexual functioning in the elderly. These chapters may be particularly useful because discussion of sexual issues with these 2 patient groups elicits more discomfort than discussion with adults in middle age.

I agree with the authors that sexual problems, although prevalent and important, are often neglected in psychiatric practice. Anyone with an interest in refining their evaluation and treatment of sexual disorders will benefit themselves and their patients by making use of this practical, well-written, and well-edited manual.

Lawrence A. Labbate, MD

llabbate@uams.edu

Author affiliation: College of Medicine of the University of Arkansas for Medical Sciences, Little Rock.

Potential conflicts of interest: None reported.

doi:10.4088/JCP.10bk06341whi

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