Psychiatric Bulletin (2007) 31: 399. doi: 10.1192/pb.31.10.399
© 2007 The Royal College of Psychiatrists
Awareness of psychosexual problems in psychiatric patients among trainees in Pakistan
Rameez Zafar, Consultant Psychiatrist
Lincolnshire Partnership NHS Trust, email:
rameez.zafar{at}lpt.nhs.uk
Khurram Sadiq, Senior House Officer in Forensic Psychiatry
Lincolnshire Partnership NHS Trust
Dr Raffi (Psychiatric Bulletin, June 2007, 31,
233–234) has raised some interesting points about sexual dysfunction
among patients of south-east Asian background. This is an issue which
psychiatrists working in south-east Asian countries face routinely in their
clinical practice.
We recently carried out a survey among psychiatric trainees in a teaching
hospital in Peshawar, Pakistan enquiring about their awareness and
understanding of psychosexual problems in psychiatric patients. Sixteen
doctors (15 males, 1 female; age range 28–42 years) completed the
questionnaire and, although all were aware of the existence and likely causes
of sexual dysfunction in psychiatric patients, only 6 said that they were
routinely carrying out assessments of psychosexual functioning. Although most
doctors (11 out of 16) felt comfortable about assessing such patients, they
thought that patients were very uncomfortable talking about problems of such a
sensitive nature. Nearly all doctors (14 out of 16) thought that the patients
were unable to openly express themselves about their sexual problems. The most
common problems identified by doctors were reduced libido, erectile
dysfunction and premature ejaculation. Only 6 doctors thought that patients
were getting adequate help for their psychosexual symptoms; the remaining 10
said that patients were just given reassurance.
All 16 doctors felt that there was a need for specific training for the
adequate assessment and management of sexual dysfunctions in a manner which
was culturally sensitive and acceptable to these patients. The stigma
associated with psychiatric problems in general, owing to cultural and
religious barriers, was further compounding the whole issue.
It is therefore pertinent that psychiatrists, especially in low- and
middle-income countries, spend more time with patients to try to allay their
anxieties about their psychosexual problems.
