Just over a century after Freud 'invented' sexuality as a leading cause of psychiatric symptoms, a new survey shows that the majority of young psychiatrists feel uncomfortable about asking their patients about their sex lives and regard it as a subject best avoided.

In 1905, Freud published Three Essays on the Theory of Sexuality forcing the discussion of sex drive and the impact on mental health of early sexual experience into the public arena.

Now, however, psychiatrists admit they are too embarrassed to mention sexuality or enquire about sexual problems in consultations with patients, fearing that they might be misunderstood or that such questions might be upsetting.

The study, due to be published later this year in the International Journal of Clinical Practice, found that 65 per cent of trainee psychiatrists reported feeling uncomfortable about talking about psycho-sexual disorders and that they would be reluctant to initiate a conversation relating to sexuality.

'Studies have repeatedly shown that three in ten men and four in ten women have significant sexual problems and they want help and advice from doctors, including psychiatrists,' said Dr Kiran Rele, specialist registrar in adult psychiatry at the Longley Centre in Sheffield who led the research.

'Sex is not a lifestyle issue. It's a quality of life issue. Yet psychiatrists are neglecting their patients' agenda either by failing to question patients about their sex lives or even changing the subject when it is raised by a patient,' he told the annual meeting.

Psychiatrists were urged to discard such a bashful approach by Dr Kevan Wylie, a consultant in sexual medicine at Royal Hallamshire Hospital in Sheffield. 'It is a psychiatrist's job to normalise sexual disorders that are experienced by one in four of the population.'

He said psychiatrists admitting new patients should consider flagging up the issue of sexuality and to explain that sexual disorders may be related to the stresses of mental health problems. 'A psychiatrist should have the skills to gauge the patients' response and whether this is something they want to discuss at the time or in the future. By mentioning sexuality at the very first point of contact with psychiatric care, the doctor can give the patient permission to raise any problems they have during the course of their treatment,' he said.

Royal College Of Psychiatrists