PSYCHOSEXUAL PROBLEMS IN THE CONTRACEPTIVE CONSULTATION – FURTHER TREATMENT OR REFERRAL? (INTRODUCTION)
It is not always possible to identify and deal with problems as they arise in the consultation although such immediate management would be ideal. The constraints of time are inevitable: the average appointment in general practice is seven to ten minutes in length, and in a clinic the pressure from the other staff to keep up with the flow of patients may be expressed openly by interruptions or reminders of the queue of other patients waiting to be seen. Most simple, straightforward problems are best dealt with at the time that they are discovered or presented, before they are established into a malfunctioning system of behaviour. Others will need more time and effort, or require referral.
Patients also provide constraints. Just because a problem is revealed does not necesarily mean that the patient wishes to do some work on it. It may not be the right time for the patient to look at the difficulty exposed, perhaps unwittingly. A patient who revealed for the first time at the age of 38 years, that she had been sexually abused as a child, because of something that had been picked up by the doctor during a routine cervical smear, did not wish to take up the doctor’s offer of another appointment or referral to discuss it further. She felt it was better left buried (as it had been for many years), despite her difficulty in responding sexually to her husband.
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