It is essential to understand the different types of sexual disturbance in their biopsychosocial context as well as the significance of sexuality for the individual, and for the couple, with respect to reproduction, sexual pleasure, and bonding. Sexual disturbances are common, and patients therefore expect their physicians to be proficient in sexual medicine. The coverage of this subject in both undergraduate and postgraduate medical education in Germany needs to be improved.
A great number of neurological diseases exert a direct impact on sexuality, due to lesions in the central and peripheral nervous system and due to different neurological symptoms and their treatment (for example medication). The psychosocial basic needs for acceptance, intimacy, and security, which can be best fulfilled by sexual communication, attain essential importance in the situation of disease-induced helplessness. This implies that not only the experience of sexual pleasure and the functioning of reproduction can be influenced, but the partnership, too. A holistic treatment approach always requires the consideration of partnership aspects.
Between 20% and 25% of the patients seeing a doctor have sexual problems. These have various causes: somatopsychological, psychosomatic, social-somatic and psychological factors can play an important role. For an effective therapy, a biopsychosocial understanding of the development of these diseases is necessary. Tumor-patients belong to a special group who frequently develop sexual problems. There are many patients with prostate cancer who, after a radical prostatectomy, suffer from erectile dysfunction. As sexuality always has a social dimension, there is no sexual dysfunction which can be seen as separate from partnership and social environment. Hence the couple is the patient, not the malfunctioning penis. Sexual rehabilitation's main aim is therefore not the repair the malfunctioning organ but rather the improvement of the quality of the sexual relationship beyond penetration.
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