Brotto Lori A, Atallah Sandrine, Carvalho Joana, Gordon Elisabeth, Pascoal Patrícia M, Reda Mona, Stephenson Kyle R, Tavares Inês M
Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, V5Z 1M9, Canada.
Department of Obstetrics and Gynecology, American University Beirut Medical Center, Sandrine Atallah 1107 Beirut, Lebanon.
Sex Med Rev. 2025 Apr 14;13(2):118-143. doi: 10.1093/sxmrev/qeae073.
Sexual health concerns are common and significantly impact quality of life, but many people do not seek treatment due to embarrassment and other barriers. A biopsychosocial model of assessment and treatment acknowledges the biological, psychological, and social contributors to sexual difficulties and suggests that all these domains should be evaluated.
This paper provides an overview of the major psychological factors contributing to sexual difficulties and offer an evidence-based approach for primary care clinicians to assess and treat these issues.
A comprehensive literature review was undertaken focusing on articles published since the last consultation in 2016. The study findings were synthesized, critiqued, authors assigned a Grading of Recommendation as Weak or Strong following a year-long process of discussions among the committee. When a particular well-established psychological practice was not evaluated in the literature, we assigned an expert opinion recommendation.
Since the 2015 ICSM, there have been a number of high-quality trials of psychological treatments addressing sexual dysfunctions, as well as meta-analyses and systematic reviews. In some domains, there is strong evidence of psychological treatment, and primary care providers should be aware of such approaches and refer when appropriate.
This paper offers a practical guide for primary care clinicians to understand the psychological factors underlying sexual dysfunction and outlining what approaches may be appropriate for this clinician, and when the patient should be referred to a specialist. We emphasize an evidence-based approach to managing sexual dysfunctions in primary care, allowing for timely interventions. A comprehensive evaluation of biopsychosocial factors is recommended to personalize psychological interventions to overall context, including chronic diseases, mental health issues, and relationship conflicts. The initial assessment is key to developing an individualized intervention plan, which may include psychoeducation, referral for cognitive-behavioral therapy, mindfulness, or couple therapy, and consideration of medical or digital health interventions.
性健康问题很常见，对生活质量有重大影响，但许多人因尴尬和其他障碍而不寻求治疗。性困难评估与治疗的生物心理社会模型认识到导致性困难的生物、心理和社会因素，并建议对所有这些领域进行评估。
本文概述了导致性困难的主要心理因素，并为初级保健临床医生评估和治疗这些问题提供循证方法。
进行了全面的文献综述，重点关注自2016年上次会诊以来发表的文章。对研究结果进行了综合、批判，经过委员会长达一年的讨论，作者将推荐等级评定为弱或强。当文献中未对某种特定的成熟心理实践进行评估时，我们给出专家意见推荐。
自2015年国际性医学学会会议以来，有多项针对性功能障碍的心理治疗高质量试验，以及荟萃分析和系统评价。在某些领域，有强有力的证据支持心理治疗，初级保健提供者应了解这些方法并在适当的时候进行转诊。
本文为初级保健临床医生提供了一份实用指南，以了解性功能障碍背后的心理因素，并概述哪些方法可能适合该临床医生，以及何时应将患者转诊给专科医生。我们强调在初级保健中采用循证方法管理性功能障碍，以便及时进行干预。建议对生物心理社会因素进行全面评估，以使心理干预适应整体情况，包括慢性病、心理健康问题和关系冲突。初始评估是制定个性化干预计划的关键，该计划可能包括心理教育、转介接受认知行为疗法、正念训练或夫妻治疗，以及考虑医学或数字健康干预措施。
