Let's talk about sex. (Guest Editorial).

Now more than ever, it's important for physicians to have a broad perspective on the subject of sexual health.

Today's consumers are much more sophisticated. They are inundated with information about what should be considered normal, healthy or functional, and most find themselves not measuring up. Part of the problem is that the definition of sexual health is overly restrictive and generally synonymous with penetration or genital stimulation. Using language that refers to levels of intimate touch in a more inclusive way provides a more expanded framework for thinking about sexuality. Penetration is an option and should not be synonymous with "sex."

Because of what has been referred to as the "Viagratization of America," there is an increased emphasis on searching for the magic bullet and a return to performance orientation, rather than understanding symptoms from a broader biopsychosocial context. The key to accurate diagnosis and treatment depends upon the contextualization of sexual symptoms within the individual and! or relationship. Although Viagra and other similar medications are helpful with vasocongestive response, they do nothing to address the underlying dynamics that interfere with intimacy or the desire for sexual closeness.

As with all medications, we have to measure the risks and benefits and have more large-scale, randomized, double-blind studies to sort out placebo response from actual response. We don't know how to evaluate some of the reported claims of female sexual enhancement attributed to the plethora of creams, lotions, and potions currently on the market. The good news is that female sexuality is being given more attention by the drug companies. Research in this area is long overdue.

Although women may ask for Viagra, the evidence for improvement in women who have primary psychosexual distress is not impressive. Recent findings indicate that the ideal female candidates for Viagra are those who have experienced a change in sexual functioning (were once sexually satisfied but are no longer), suggesting a secondary result due to surgery or an underlying medical condition. These are women who feel good about themselves and their bodies and have no history of abuse or trauma.

All sexual symptoms exist in context. Time constraints in the office make it hard to pay attention to the process, but a sexual function problem could be an indicator of a number of problems beneath the tip of the iceberg. A presenting problem of desire, arousal, or response could indicate a range of underlying medical or psychological difficulties.

Depression is often a problem whose treatment further complicates the presenting complaint. A woman may complain of hypoactive sexual desire secondary to ...