Awareness and management of psychosexual and relationship problems in mental health services
Kiran Rele, Kevan Wylie

Knowledge of psychosexual development and competency in the assessment and treatment of psychosexual disorder should be core components of psychiatry residency curriculum and psychiatric training (Scheiber et al, 2003; Nnaji & Friedman, 2008). Research indicates that many psychiatric training schemes fail to teach a broad range of human sexuality issues and that expert supervision and clinical training opportunities are lacking (Verhulst, 1992).

We undertook a study that monitored the assessment and training in psychosexual and relationship problems in general mental health services (Rele & Wylie, 2007). We devised a questionnaire that asked psychiatry trainees to report their perception of competency in dealing with service users’ sexual dysfunction and relationship problems, the need to discuss potential sexual side-effects before and after starting psychotropic medication and the importance of a readily available psychosexual disorder clinic. In addition, we enquired about the emphasis, or otherwise, on psychosexual disorders and sexual health problems in general, both in medical school and during current psychiatric training. All psychiatry trainees (both basic and higher specialist trainees in adult and old age psychiatry) in the mid-Trent rotation were invited to complete the questionnaire.

Only 24% of trainees reported that they routinely ask service users about psychosexual history; of these, 65% felt comfortable about taking a detailed psychosexual history. The majority of participants (81%) felt they have received inadequate training and did not feel competent dealing with service users with a psychosexual disorder. Only 30% of trainees reported asking service users about sexual health side-effects when on psychotropic medication. All trainees preferred to refer the person to a local psychosexual disorder clinic (if available) rather than treat them themselves. To our knowledge, this was the first survey on competency of UK-based psychiatric trainees in taking a sexual and relationship history and management of sexual dysfunction of their patients.

Taking a sexual and relationship history should be an integral part of any psychiatric assessment. Nnaji & Friedman (2008) have failed to highlight the importance of a healthy relationship in their paper. Healthcare professionals need to be alert to the possibility of a sexual problem in service users and should be competent enough to be able to discuss it. Training in sexuality should be introduced in medical schools as a part of the undergraduate curriculum and a core part of psychiatric training curriculum, and trainees should be tested for their competency in dealing with sexual dysfunctions.