OTHER ISSUES OF DYSFUNCTION
227. The controversy over sildenafil has perhaps
served to mask the wider issues relating to sexual dysfunction.
Dr Pat Munday felt this was a very serious problem. Her work had
convinced her that:
there is an enormous amount of sexual dysfunction
which is under the surface and which we as clinicians in general
practice and in GU medicine constantly see and we see the consequences
of that. In women it is much more tenuous and difficult to identify
because it tends to present with medico-organic type problems
whereas in men it tends to present with pure erectile dysfunction
... It is because of the cost which attaches to erectile dysfunction
that there has been some anxiety about it. But it is only a small
part of the whole sexual dysfunction agenda.[201]
228. Jackie Rogers, a clinical nurse specialist in
GUM, told us that sexual dysfunction therapy was very time consuming
and expensive. Most therapists would see a patient for an hour
and would have contact with them over a long period of time. While
a few clinics had taken on therapists they were generally regarded
as a "luxury".[202]
Chris Ford confirmed that a therapist in a PCT adjoining hers
had a year's waiting list, obliging her to muddle through with
whatever advice she could give. If GUM services were the Cinderella
of the NHS, then, in her view, services for sexual dysfunction
represented "the Cinderella of Cinderella services".[203]
The resources around dysfunction were "almost non-existent"
in her area.
229. For the Department, Cathy Hamlyn, Head of Sexual
Health and Substance Abuse, affirmed that the Action Plan contained
a clear commitment to the development of psycho-sexual services,
that include sexual dysfunction".[204]
There is scant mention of sexual dysfunction in the Strategy
and our evidence suggests that the Action Plan commitment is not
yet a reality for those people suffering from serious sexual dysfunction.
230. We fully accept that any Government has to
balance competing priorities and pressures in respect of public
expenditure. We do, however, find it indicative of the priority
accorded to sexual health, and sexual dysfunction services in
particular, that access to anti-impotence services and drugs is
so restricted. Effectively, the Government is dealing with this
more as a lifestyle issue than a health issue, and that seems
to us to be wrong. It is simply not appropriate that so many men
and women with a clear medical and psychological need are not
having access to these treatments, leading to a situation where
only those who can afford it are likely to use them. This seems
to us contrary to the fundamental principles of the NHS. We therefore
recommend that access to anti-impotence treatments should be reviewed.
We also think it would be helpful if the Department commissioned
research to establish the costs and benefits of a more liberal
prescribing regime, given the likely savings which might accrue
in areas such as the treatment of depression, infertility, and
dealing with the consequences of marital breakdown. Given the
lack of development of sexual dysfunction services, and the fact
that social pressures are such that those suffering will often
be shy and unwilling to articulate their case, we call on the
Department to include sexual dysfunction within the wider sexual
health strategy.
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