When should I refer a patient with sexual dysfunction to a specialist for further evaluation?

Refer a patient with sexual dysfunction to a specialist for further evaluation if:

• There are persistent or unexplained symptoms that may indicate underlying pathology, such as pain during sexual activity, sensory changes, or urinary and bowel symptoms associated with sexual dysfunction.
• There is suspicion of neurological disease or complications related to previous pelvic surgery or mesh implantation.
• The patient has symptoms suggestive of mesh-related complications, including palpable, exposed, or extruded mesh, or unexplained pain related to prior mesh procedures.
• Initial management in primary care has not resolved bothersome symptoms, or if there are complex or unclear causes requiring specialist assessment.
• There are signs that raise concern for malignancy or other serious conditions, such as unexplained lumps, ulcers, or erectile dysfunction warranting prostate evaluation.

In these cases, referral to an appropriate specialist such as a urologist, urogynaecologist, or colorectal surgeon is recommended for detailed assessment and management planning NICE NG123,NICE NG12.