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07. Communicating About Sexual Function: A Clinical Imperative

Published on April 1, 2026 Certification expiration date: April 1, 2029

Anita Clayton, M.D., D.L.F.A.P.A., I.F.

Wilford W. Spradlin Professor and Chair of Psychiatry - University of Virginia School of Medicine, Charlottesville, VA

Key Points

  • Make sexual function questions part of every routine exam, framing them alongside habits and quality-of-life topics.
  • Over 75% of patients worry that no treatment exists for sexual concerns, so proactively provide reassurance and education.
  • Consider systematically assessing each phase of the sexual response cycle and identify modifiable factors before initiating specific treatments.

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Slides and Transcript

Slide 1 of 9

In this section, we’ll be talking about communicating about sexual function. It’s really a clinical imperative.

Slide 2 of 9

Open communication between the patient and the provider is first the responsibility of the patient. This is in part driven by how people feel about their sex life. In a US poll of adults 25 years or older, 85% indicated they would bring up sexual problems with their provider even if there might not be a treatment.
References:
  • Marwick, C. (1999). Survey says patients expect little physician help on sex. JAMA, 281(23), 2173–2174. https://doi.org/10.1001/jama.281.23.2173
  • Clayton, A. H. (2014, April 18). Overcoming barriers to discussing sexual dysfunction. Current Psychiatry/MDedge. https://tinyurl.com/58p93j7e
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Slide 3 of 9

This is because a satisfying sex life was found to be important in 91% of married men and 84% of married women. 94% of people reported that sexual enjoyment adds to their quality of life and that sexual difficulties cause emotional and relationship problems.
References:
  • Marwick, C. (1999). Survey says patients expect little physician help on sex. JAMA, 281(23), 2173–2174. https://doi.org/10.1001/jama.281.23.2173

Slide 4 of 9

However, if the patient does not bring up the topic of sexual function, the responsibility is on the provider to address it. How can you do that? One, initiate the discussion. Make it part of the routine exam either as part of questions about habits or quality of life, and indicate that you talk about this with patients routinely.
References:
  • Kingsberg, S. A., Schaffir, J., Faught, B. M., Pinkerton, J. V., Parish, S. J., Iglesia, C. B., Gudeman, J., Krop, J., & Simon, J. A. (2019). Female sexual health: Barriers to optimal outcomes and a roadmap for improved patient-clinician communications. Journal of Women's Health, 28(4), 432–443. https://doi.org/10.1089/jwh.2018.7352
  • Clayton, A. H. (2014, April 18). Overcoming barriers to discussing sexual dysfunction. Current Psychiatry/MDedge. https://tinyurl.com/58p93j7e
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Slide 5 of 9

It’s important to elicit patient preferences because if it’s important to the patient it should be important to you, and you should consider those preferences in any potential intervention. You want to identify problems in desire, arousal, orgasm, pain and satisfaction, and you want to address modifiable factors and potentially prescribe specific treatments to patients.
References:
  • Kingsberg, S. A., Schaffir, J., Faught, B. M., Pinkerton, J. V., Parish, S. J., Iglesia, C. B., Gudeman, J., Krop, J., & Simon, J. A. (2019). Female sexual health: Barriers to optimal outcomes and a roadmap for improved patient-clinician communications. Journal of Women's Health, 28(4), 432–443. https://doi.org/10.1089/jwh.2018.7352
  • Clayton, A. H. (2014, April 18). Overcoming barriers to discussing sexual dysfunction. Current Psychiatry/MDedge. https://tinyurl.com/58p93j7e

Slide 6 of 9

When looking at provider-patient communications about concerning sexual problems. In a survey about where patients were asked, if you wanted to talk to your doctor about a sexual problem you were having, how concerned would you be that each of the following might happen during your doctor’s visit? And they were very or somewhat concerned in over 75% of the people that there would be no medical treatment for their problem. In about 70%, patients said they thought their doctor would dismiss their concerns saying it was all in their head.
References:
  • Marwick, C. (1999). Survey says patients expect little physician help on sex. JAMA, 281(23), 2173–2174. https://doi.org/10.1001/jama.281.23.2173
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Slide 7 of 9

And when asked about would your doctor be uncomfortable talking about the problem because it was sexual in nature, nearly 70% of the polled individuals responded. So the provider needs to indicate that there is not discomfort on their part and that you want to know about their problems because there are potential interventions that might help them.
References:
  • Marwick, C. (1999). Survey says patients expect little physician help on sex. JAMA, 281(23), 2173–2174. https://doi.org/10.1001/jama.281.23.2173

Slide 8 of 9

So the key points in this section: Open communication is important. Patients may hesitate to bring up sexual dysfunction due to fear the provider would dismiss their sexual dysfunction concerns, would be uncomfortable with the topic or that there would be no interventions available. Whatever the patient concerns, the provider must introduce the topic of sexual function and make the patient feel safe to discuss it.
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Slide 9 of 9

The best way is to make such questions part of the routine exam. And providers should ask about each phase of the sexual response cycle, about patient distress regarding the problem and potential modifiable factors and then offer available interventions or treatments.

Learning Objectives:

  1. Identify the neurotransmitter, hormonal, and genetic factors that contribute to psychotropic-induced sexual dysfunction and differentiate medication effects from disease-related and non-psychiatric causes.
  2. Compare the sexual dysfunction profiles of antidepressants, antipsychotics, and mood stabilizers to select agents with lower risk based on clinical trial evidence.
  3. Apply a stepwise management approach — including modifiable factor assessment, medication substitution, and adjunctive antidote strategies — to individualize treatment while maintaining psychiatric stability.

Original Release Date: April 01, 2026
Expiration Date: April 01, 2029

Faculty: Anita Clayton, M.D.
Medical Editor: Tomás Abudarham, M.D.

Relevant Financial Disclosures:
Anita Clayton declares the following interests:
– Janssen: Grants/Research Contracts
– Neumora Therapeutics
– Neurocrine Biosciences
– Otsuka
– Relmada Therapeutics, Inc.
– Reunion Neuroscience, Inc.
– S1 Biopharma
– Autobahn Therapeutics
– Daré Bioscience
– AbbVie, Inc.: Advisory Board Fee/Consultant Fee
– Actinogen
– AdhereTech
– Axsome Therapuetics
– Biogen, Inc.
– Fabre-Kramer Pharmaceuticals
– Initiator Pharma
– Intra-cellular Therapies
– Janssen Research & Development, LLC
– LIVANOVA PLC
– MycoMedica Life Sciences, PBC
– P/S/L Group Services
– Seaport Therapeutics
– Sirtsei Pharmaceuticals, Inc.
– Vella Bioscience, Inc.
– Royalties/Copyright: Ballantine Books/Random House
– Changes in Sexual Functioning Questionnaire
– Guilford Publications
– Shares/Restricted Stock Units: Mediflix LLC

All the relevant financial relationships listed above have been mitigated by Medical Academy and the Psychopharmacology Institute.

None of the other faculty, planners, and reviewers for this educational activity has relevant financial relationships to disclose during the last 24 months with ineligible companies whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

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