1.2 Orientation

The focus of this phase is forming a picture of the problem and the patient as a problem solver. Therefore it is important to start with the patient’s view on the problem. This requires special attenton in the sexual history taking process. The patient’s comments are assessed against the professional’s own frame of reference and in necessary, the results of a physical examination. During this examination sexual anatomy and physiology are explained and if necessary myths are dispelled. The care provider must apply his own frame of reference because the patient’s account can be colored by certain norms and values. The key question is whether there is a normal sexual response, i.e. whether some form of stimulation is possible, be it tactile or through erotic thoughts or fantasies, whereby sexual arousal and sexual desire develop and will lead to orgasm if desired. If the response mechanism is not disrupted (e.g. the patient responds adequately during masturbation or during contact with another partner), attention must shift to the interaction with his or her current partner. What is so different as to create a sexual problem? If however there is a disrupted sexual response, attention should be given to the question of when – in which phase(s) – it is inadequate. If necessary in this phase self-help books, educational videos and folders about sexual problems can be useful.