Sexual Health

Last updated 1 Jun 2026 · General Practice / Sexual Health

📋 Key Information Summary

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Sexual dysfunction affects approximately 34% of Australian women and 25% of Australian men; prevalence increases with age and comorbidity but is not an inevitable consequence of ageing.
Routine enquiry about sexual health should be incorporated into general practice consultations — most patients will not raise concerns spontaneously; use the PLISSIT model (Permission, Limited Information, Specific Suggestions, Intensive Therapy) to guide the conversation.
A structured sexual history using the "5 Ps" framework (Partners, Practices, Past STIs, Protection, Pregnancy) provides a systematic approach applicable across all presentations.
Female sexual dysfunction encompasses hypoactive sexual desire disorder (HSDD), female orgasmic disorder, genito-pelvic pain/penetration disorder (GPPPD/dyspareunia), and arousal disorder — biopsychosocial assessment is essential.
Dyspareunia requires distinction between superficial (introital) and deep (vaginal/vault) pain; causes include vulvodynia, vaginal atrophy, endometriosis, pelvic adhesions, and pelvic floor hypertonicity.
Vaginal oestrogen (e.g., Vagifem® / Ovestin®) is first-line for genitourinary syndrome of menopause causing dyspareunia; vaginal DHEA (Prasterone / Intrarosa®) is an alternative — both available on PBS for postmenopausal women.
Erectile dysfunction (ED) in a man aged <60 years or with acute onset warrants cardiovascular risk assessment — ED may be the earliest clinical marker of endothelial dysfunction and coronary artery disease.
PDE5 inhibitors (sildenafil, tadalafil, vardenafil) remain first-line for ED; tadalafil 5 mg daily is preferred when sexual activity is frequent (>2/week) or when lower urinary tract symptoms coexist — all are PBS-listed as Authority Required.
Low libido in men and women often has a multifactorial aetiology: medication side effects (SSRIs, anti-androgens, opioids), relationship distress, depression, hormonal deficiency, and chronic illness must all be addressed.
Testosterone therapy for postmenopausal HSDD may be considered when other causes are excluded; testosterone undecanoate (AndroFeme®) is TGA-approved for women in Australia, though not PBS-listed for this indication.
Always consider the partner's perspective and offer couple-based referral where appropriate; referral pathways include sexual health physicians, pelvic floor physiotherapists, psychologists (especially those trained in CBT for sexual concerns), and specialist gynaecologists.
Aboriginal and Torres Strait Islander Australians experience higher rates of STIs, barriers to culturally safe sexual health discussions, and unique psychosocial determinants that impact sexual wellbeing — a trauma-informed, shame-free approach is mandatory.

Introduction & Australian Epidemiology

Sexual health is a fundamental component of overall wellbeing, as defined by the World Health Organization: "a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity." Despite this, sexual dysfunction remains significantly under-recognised and under-treated in Australian general practice, with studies suggesting that fewer than 20% of affected individuals ever discuss their concerns with a GP.

The Australian Longitudinal Study of Health and Relationships (ASHR) and the more recent Second Australian Study of Health and Relationships (ASHR2) provide the most robust population-level data. Key findings include:

Women: Approximately 34% report at least one sexual difficulty lasting ≥3 months in the preceding year — most commonly low desire (reported by ~55% of women with any difficulty), difficulty with arousal (~26%), and difficulty achieving orgasm (~21%).
Men: Approximately 25% report at least one sexual difficulty — most commonly erectile difficulties (~16%), premature ejaculation (~15%), and low desire (~10%).
Age trends: Prevalence of erectile dysfunction rises from ~8% in men aged 20–29 to >60% in men over 70; postmenopausal women report higher rates of dyspareunia and desire concerns.
Psychosocial impact: Sexual dysfunction is strongly associated with depression, anxiety, relationship dissatisfaction, and reduced quality of life in both sexes.

In Australia, sexual health consultations in general practice are funded under Medicare, with standard Level B–D consultation items (items 3, 23, 36) applicable. No specific MBS item exists for sexual dysfunction assessment alone, but extended consultations (Level C, item 36; Level D, item 44) are recommended to allow adequate time for sensitive history-taking and biopsychosocial formulation.

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Practice point: Sexual dysfunction is frequently multifactorial. A purely biomedical approach (e.g., prescribing a PDE5 inhibitor without addressing relationship issues, medication causes, or psychological comorbidity) leads to high treatment failure rates and patient disengagement.

Sexual Difficulties & Dysfunction Presentations

Sexual dysfunction encompasses a broad spectrum of conditions classified by the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th edition) and the ICD-11 (International Classification of Diseases, 11th revision). The key principle is that a sexual concern must cause marked personal distress or interpersonal difficulty to warrant a formal diagnosis — the absence of a problem-free sexual encounter is not itself pathological.

Classification Overview

Domain	Female	Male
Desire	Female Sexual Interest/Arousal Disorder (FSIAD) — combines desire and arousal in DSM-5	Male Hypoactive Sexual Desire Disorder (MHSDD)
Arousal	Included within FSIAD; historically Female Arousal Disorder	Erectile Disorder / Erectile Dysfunction (ED)
Orgasm	Female Orgasmic Disorder	Delayed Ejaculation; Premature Ejaculation (PE)
Pain	Genito-Pelvic Pain/Penetration Disorder (GPPPD) — merges vaginismus and dyspareunia	Genito-Pelvic Pain/Penetration Disorder (less common)

Common Presenting Complaints in General Practice

"I'm just not interested anymore" — reduced desire/libido (m or f)
"I can't get or keep an erection" — erectile difficulties
"Sex is painful" — dyspareunia (superficial or deep)
"I can't reach orgasm" — anorgasmia or delayed orgasm
"It happens too quickly" — premature ejaculation
"I avoid sex altogether" — sexual aversion (often related to past trauma)
Vague presentation: fatigue, relationship conflict, low mood — may mask underlying sexual concerns

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Red flags requiring urgent assessment: Sudden onset ED in a young man (<40 years) may indicate endocrine pathology (hyperprolactinaemia, hypogonadism) or occult cardiovascular disease. Acute painful vulval/vaginal lesions require exclusion of malignancy. New-onset Peyronie's disease warrants urological review.

The Biopsychosocial Model

Every sexual dysfunction should be conceptualised through a biopsychosocial lens:

Biological

Hormonal (menopause, hypogonadism, thyroid disease), vascular (diabetes, hypertension, peripheral vascular disease), neurological (multiple sclerosis, spinal cord injury), medication side effects, pelvic surgery/radiotherapy, chronic illness

Psychological

Depression, anxiety, performance anxiety, body image concerns, history of sexual trauma or abuse, cognitive distortions about sex, stress, fatigue

Social / Relational

Relationship conflict or poor communication, partner's sexual dysfunction, infidelity, cultural or religious attitudes, sexual orientation concerns, isolation, lack of privacy

Taking a Sexual History

Effective sexual history-taking is the cornerstone of assessment. The Australian Government's STI & BBV Testing Guidelines recommend that GPs ask about sexual health proactively rather than waiting for patients to raise concerns. Several validated frameworks exist to guide this conversation.

Creating a Safe Environment

Ensure confidentiality is explicitly stated — particularly for adolescents and patients in small communities.
Use gender-neutral and inclusive language (e.g., "partner" rather than "husband/wife").
Normalise the topic: "I ask all my patients about sexual health as part of a routine check-up."
Allow adequate time — a minimum 20-minute appointment (MBS item 23 or longer) is recommended.
Consider offering a same-sex practitioner if the patient expresses a preference, but do not assume this is required.

The PLISSIT Model

The PLISSIT model (Annon, 1976) provides a graduated framework for intervention that is well-suited to general practice:

Permission

Give explicit permission to discuss sexual concerns. Validate that sexual difficulties are common and treatable. "Many people experience changes in their sexual function — would you like to talk about it?"

Limited Information

Provide targeted, condition-specific information. For example, explaining how SSRIs commonly affect desire and orgasm, or that vaginal dryness after menopause is a treatable hormonal change, not a personal failing.

Specific Suggestions

Offer evidence-based, condition-specific interventions. This is where the GP prescribes medication, refers to pelvic floor physiotherapy, recommends sensate focus exercises, or adjusts contributing medications.

Intensive Therapy

For complex or refractory cases, refer to specialist sexual health physicians, psychosexual therapists, urologists, gynaecologists, or endocrinologists. This level exceeds the scope of routine general practice.

The "5 Ps" Framework

Adapted from the CDC and endorsed by the Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM), the 5 Ps provide a systematic sexual history structure:

P	Area	Example Questions
Partners	Number, gender, new/recent	"Do you have sex with men, women, or both?" "How many sexual partners have you had in the past 12 months?"
Practices	Types of sexual contact	"What types of sexual contact do you have — vaginal, oral, anal?"
Past STIs	Previous diagnoses and treatment	"Have you ever been diagnosed with an STI? When was your last STI screen?"
Protection	Condom use, PrEP, contraception	"How often do you use condoms? Are you on any form of contraception?"
Pregnancy	Current plans, history	"Is pregnancy a possibility or a goal for you or your partner?"

Validated Screening Tools

Arizona Sexual Experiences Scale (ASEX): 5-item self-report scale assessing drive, arousal, erection/lubrication, orgasm satisfaction, and orgasm latency — useful as a quick screening tool.
Female Sexual Function Index (FSFI): 19-item validated questionnaire covering desire, arousal, lubrication, orgasm, satisfaction, and pain — the gold standard for female sexual dysfunction research.
International Index of Erectile Function (IIEF): 15-item questionnaire — the most widely validated tool for ED assessment; domain scores guide severity classification.
Sexual Health Inventory for Men (SHIM): 5-item abbreviated version of the IIEF — practical for general practice use.
Patient Health Questionnaire-9 (PHQ-9): Not specific to sexual health but essential for screening comorbid depression, which is present in up to 50% of patients with sexual dysfunction.

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GP Tip: If a patient declines to discuss sexual health, respect their boundary and leave the door open: "That's completely fine. If you ever want to discuss it in the future, I'm here and this is a confidential space." Document the offer was made.

Female Sexual Dysfunction

Female sexual dysfunction (FSD) encompasses a range of conditions that affect desire, arousal, orgasm, and pain during sexual activity. Prevalence estimates in Australian women range from 30–50%, depending on the population studied and the diagnostic criteria used. Importantly, FSD is often under-reported due to embarrassment, normalisation ("I thought it was just part of being a woman/mother/menopausal woman"), and inadequate enquiry by clinicians.

Hypoactive Sexual Desire Disorder (HSDD) / Female Sexual Interest–Arousal Disorder (FSIAD)

Characterised by persistently reduced or absent sexual interest/arousal causing personal distress. The DSM-5 combined desire and arousal into a single diagnosis (FSIAD), though many clinicians still use the term HSDD clinically.

Aetiology

Hormonal: Menopause (natural or surgical), premature ovarian insufficiency, hyperprolactinaemia, hypothyroidism, hormonal contraception (especially combined oral contraceptives via SHBG elevation and free testosterone reduction), anti-oestrogen therapy (tamoxifen, aromatase inhibitors).
Medications: SSRIs/SNRIs (affect up to 70% of users), antipsychotics, anticonvulsants, opioids, beta-blockers, spironolactone.
Psychological: Depression, anxiety, stress, body image concerns, history of sexual abuse, relationship conflict, sexual boredom or monotony.
Relational: Unresolved conflict, power imbalances, partner's sexual dysfunction, infidelity, poor communication about sexual needs.

Assessment

Determine if the concern is lifelong (primary) or acquired (secondary), generalised or situational.
Exclude hormonal causes: consider TSH, prolactin, free testosterone (morning sample), SHBG, oestradiol, FSH/LH if perimenopausal.
Assess relationship quality and mental health (PHQ-9, GAD-7).
Use the FSFI or ASEX to document baseline severity.

Management

Address Modifiable Factors

Switch SSRIs to agents with lower sexual side-effect profiles (bupropion, mirtazapine, vortioxetine, agomelatine). Review hormonal contraception. Treat depression, anxiety, and relationship dysfunction.

Psychoeducation & Behavioural Strategies

Sensate focus exercises (Masters & Johnson), directed masturbation for anorgasmia, mindfulness-based sex therapy. Psychosexual counselling referral (Medicare-rebated under Mental Health Treatment Plan, item 80110 for eligible psychologists).

Pharmacotherapy

See drug cards below — testosterone for postmenopausal HSDD, flibanserin, topical therapies for arousal concerns.

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Testosterone Undecanoate (oral)

Andriol® · Testosterone replacement

Indication Off-label for postmenopausal HSDD when other causes excluded

Adult dose 40–80 mg PO BD with food; aim for free testosterone in mid-normal range for premenopausal women

Duration Trial of 3–6 months; discontinue if no benefit at 6 months

Key monitoring Free testosterone, SHBG, LFTs at baseline, 3 months, 6 months, then 6-monthly. Monitor for acne, hirsutism, voice deepening.

PBS status ✘ Not PBS for female HSDD (off-label use; private prescription)

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Testosterone 1% Cream

AndroFeme® · Compounded options also used

Indication Postmenopausal HSDD — TGA-approved formulation for women

Adult dose 5 mg (0.5 mL) applied to inner thigh or lower abdomen once daily in the morning

Duration Trial ≥3 months; reassess at 6 months; long-term use requires ongoing monitoring

Key monitoring Serum testosterone (trough, 24 h post-application) at 3 and 6 weeks, 3 months, then 6-monthly. Target: premenopausal range.

PBS status ✘ Not PBS listed for women (Special Access Scheme or private prescription)

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Flibanserin

Addyi® · 5-HT₁A agonist / 5-HT₂A antagonist

Indication Pre-menopausal HSDD (generalised, acquired)

Adult dose 100 mg PO once daily at bedtime

Cautions Contraindicated with alcohol (hypotension risk); avoid with strong CYP3A4 inhibitors; common side effects: dizziness, somnolence, nausea

PBS status ✘ Not TGA-approved / Not PBS (not currently available in Australia; FDA-approved in US only)

Orgasmic Difficulties in Women

Female orgasmic disorder is defined as persistent difficulty, delay in, or absence of orgasm following a normal excitement phase, causing distress. It affects an estimated 10–15% of Australian women.

Management Approach

Step 1 — Education: Explain the clitoral versus vaginal orgasm debate; approximately 70–80% of women require direct clitoral stimulation for orgasm. Reassure that this is normal physiology.
Step 2 — Directed masturbation: Evidence-based technique involving progressive self-exploration, body mapping, and introduction of vibrator use. The Betty Dodson method or sensate focus programme may be recommended.
Step 3 — Couples therapy: Where relational dynamics contribute, refer for psychosexual counselling. Address performance anxiety, communication deficits, and sexual scripts.
Step 4 — Medication review: SSRIs are the most common medication-related cause. Options include dose reduction, drug holidays (e.g., skip Saturday dose of sertraline for weekend intimacy), switching to bupropion, or augmentation with bupropion 150 mg SR daily.

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Vibrators and aids: The Therapeutic Goods Administration (TGA) classifies vibrators as consumer products rather than medical devices. GPs can recommend their use without regulatory concern. No prescription is required.

Dyspareunia & Genito-Pelvic Pain/Penetration Disorder (GPPPD)

Dyspareunia (painful intercourse) affects 8–22% of Australian women. The DSM-5 diagnosis of GPPPD merges the previously separate diagnoses of vaginismus and dyspareunia, reflecting the significant clinical overlap between these conditions.

Classification by Pain Location

Superficial / Introital

Pain at the vaginal entrance

Vulvodynia, provoked vestibulodynia, lichen sclerosus, lichen planus, recurrent candidiasis, Bartholin's cyst, postpartum perineal trauma, pelvic floor hypertonicity

Assessment: Vulval examination, vaginal swabs if discharge, consider dermatology referral

Deep / Vaginal

Pain with deep penetration

Endometriosis, adenomyosis, pelvic adhesions, ovarian cysts, uterine fibroids, pelvic inflammatory disease, retroverted uterus, cervical pathology

Assessment: Bimanual examination, pelvic ultrasound (MBS item 55066), consider gynaecology referral

Post-menopausal

Genitourinary syndrome of menopause (GSM)

Vaginal dryness, burning, irritation, dyspareunia due to oestrogen deficiency; affects up to 50% of postmenopausal women

First-line: Vaginal oestrogen; Second-line: Vaginal DHEA; Referral if refractory

Management of Dyspareunia

Treat Underlying Cause

Vulval dermatoses → topical corticosteroids (dermatology co-management). Endometriosis → hormonal suppression or surgical referral. Infection → targeted antimicrobial therapy.

Vaginal Oestrogen

First-line for GSM. Options: oestradiol pessaries (Vagifem® 10 mcg), oestriol cream (Ovestin® 0.1%), or oestradiol vaginal ring (Estring®). Effect typically seen within 4–8 weeks; long-term use is safe at recommended doses.

Pelvic Floor Physiotherapy

Essential for pelvic floor hypertonicity, vaginismus, and vulvodynia. Refer to a pelvic floor physiotherapist (available via Medicare CDM items 10960/10961 with GP Management Plan). Includes desensitisation, dilator therapy, and myofascial release.

Pharmacotherapy for Vulvodynia

Topical lidocaine 5% ointment PRN, amitriptyline 10–75 mg nocte, gabapentin 300–900 mg TDS, or nortriptyline as second-line neuromodulators. Compounded topical creams (amitriptyline 2%/baclofen 2%) may be used under specialist guidance.

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Oestradiol Pessaries

Vagifem® 10 mcg · Oestrogen replacement (vaginal)

Adult dose 1 pessary intravaginally nightly for 2 weeks, then 1 pessary twice weekly maintenance

Duration Long-term — reassess need annually; safe continuation at low dose

Key cautions Not associated with increased VTE/endometrial cancer risk at vaginal doses; unexplained vaginal bleeding requires investigation before starting

PBS status ✔ PBS General Benefit

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Oestriol Cream

Ovestin® 0.1% · Oestrogen replacement (vaginal)

Adult dose 0.5 mg (0.5 g cream) intravaginally nightly for 2–4 weeks, then twice weekly

Duration Long-term maintenance; reassess annually

PBS status ✔ PBS General Benefit

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Prasterone (Vaginal DHEA)

Intrarosa® 6.5 mg · Androgen/steroid intravaginal

Adult dose 1 pessary intravaginally at bedtime nightly

Indication Moderate to severe dyspareunia due to vulvovaginal atrophy in postmenopausal women

PBS status ⚠ PBS Authority Required — when vaginal oestrogen contraindicated or inadequate response

Male Sexual Dysfunction

Male sexual dysfunction presents to Australian general practice primarily as erectile dysfunction (ED), premature ejaculation (PE), and low libido. The Second Australian Study of Health and Relationships reported that 25% of men experienced at least one sexual difficulty in the past year, yet fewer than one-third sought medical attention.

Erectile Dysfunction (ED)

ED is defined as the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance. It is the most common male sexual complaint in general practice and is increasingly recognised as an early marker of systemic vascular disease.

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Cardiovascular warning: ED precedes symptomatic coronary artery disease by a mean of 3–5 years. In men aged 30–60 with new-onset ED and no obvious cause, perform a cardiovascular risk assessment (absolute CVD risk calculator, fasting lipids, HbA1c, BP) and consider cardiology referral if intermediate or high risk (>10% 5-year CVD risk).

Aetiology

Category	Examples
Vascular	Atherosclerosis, hypertension, hyperlipidaemia, diabetes mellitus, smoking, pelvic/perineal trauma
Neurological	Diabetic neuropathy, multiple sclerosis, spinal cord injury, post-radical prostatectomy
Hormonal	Hypogonadism (total testosterone <8 nmol/L), hyperprolactinaemia, hypothyroidism, Cushing's syndrome
Medications	Antihypertensives (thiazides, beta-blockers), antidepressants (SSRIs, TCAs), antipsychotics, anti-androgens, opioids, finasteride
Psychogenic	Performance anxiety, depression, relationship conflict, history of sexual trauma — classically sudden onset with preserved morning erections

Assessment

History: Onset (sudden vs gradual), context (situational vs generalised), morning erections (present = likely psychogenic), medication review, relationship factors, alcohol/smoking/recreational drugs.
Examination: BP, BMI, waist circumference, secondary sexual characteristics, testicular volume, genital examination (Peyronie's plaque), peripheral pulses, digital rectal examination if prostate pathology suspected.
Investigations: Fasting glucose or HbA1c, fasting lipid profile, total testosterone (fasting, morning 8–10 am sample), free testosterone (if total 8–12 nmol/L — the "grey zone"), SHBG, TSH, prolactin if testosterone low. Nocturnal penile tumescence testing or penile Doppler ultrasound — reserved for specialist assessment (urology/andrology referral).
Severity assessment: SHIM/IIEF questionnaire at baseline and follow-up.

Management — Stepwise Approach

Lifestyle Modification

Smoking cessation (cessation doubles improvement rates in ED), weight loss (≥5% body weight improves erectile function in obese men), regular aerobic exercise (≥150 min/week), limit alcohol (<14 standard drinks/week), address recreational drug use.

Manage Reversible Causes

Switch offending medications (e.g., change beta-blocker to ARB/CCB), treat hypogonadism (testosterone replacement if confirmed deficiency), correct thyroid dysfunction, treat hyperprolactinaemia.

First-Line Pharmacotherapy

PDE5 inhibitors — see drug cards below. Requires sexual stimulation for effect. Advise trial of ≥6 attempts at adequate dose before declaring failure.

Second-Line / Specialist Options

Intracavernosal injections (alprostadil/Caverject®), intraurethral alprostadil (MUSE®), vacuum erection devices, penile prosthesis implantation (urology).

PDE5 Inhibitors — Comparison

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Sildenafil

Viagra® · Generic · PDE5 inhibitor

Adult dose 50 mg PO 1 hour before sexual activity (range 25–100 mg); max once daily

Onset / Duration 30–60 min onset; duration 4–6 hours

Key cautions Contraindicated with nitrates/amyl nitrite; reduce dose with CYP3A4 inhibitors; avoid with severe hepatic impairment

Renal adjustment Start 25 mg if eGFR <30 mL/min

PBS status ⚠ PBS Authority Required

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Tadalafil (PRN)

Cialis® · PDE5 inhibitor

Adult dose 10 mg PO before sexual activity (range 5–20 mg); max once daily

Onset / Duration 30 min–2 hours onset; duration up to 36 hours ("weekend pill")

Key advantage Longest duration; allows more spontaneity; also improves LUTS/BPH symptoms

Renal adjustment Max 10 mg if eGFR 30–50; avoid if eGFR <30 (or 5 mg)

PBS status ⚠ PBS Authority Required

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Tadalafil (Daily)

Cialis® Daily · PDE5 inhibitor

Adult dose 5 mg PO once daily (can increase to 5 mg if 2.5 mg inadequate)

Best for Men with frequent sexual activity (≥2/week); concurrent LUTS/BPH; desire for spontaneity

Renal adjustment Max 2.5 mg daily if eGFR 30–50; not recommended if eGFR <30

PBS status ⚠ PBS Authority Required

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Vardenafil

Levitra® · PDE5 inhibitor

Adult dose 10 mg PO before sexual activity (range 5–20 mg); max once daily

Onset / Duration 25–60 min onset; duration 4–6 hours

Renal adjustment Start 5 mg if eGFR <30

PBS status ⚠ PBS Authority Required

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Absolute contraindication: PDE5 inhibitors must NOT be used with nitrates (GTN patches/spray, isosorbide mononitrate/dinitrate) or recreational amyl nitrite ("poppers"). The combination can cause life-threatening hypotension. A minimum 24-hour washout is required (48 hours for tadalafil) before commencing nitrates.

Hypogonadism & Testosterone Replacement Therapy (TRT) in Men

Testosterone deficiency (total testosterone consistently <8 nmol/L on two fasting morning samples, or 8–12 nmol/L with symptoms + low free testosterone) affects 5–10% of Australian men over 40 and is associated with reduced libido, ED, fatigue, reduced muscle mass, increased body fat, and osteoporosis.

Indications for TRT (Endocrine Society of Australia Guidelines)

Symptoms consistent with testosterone deficiency AND
Total testosterone <8 nmol/L on two separate fasting morning samples, OR
Total testosterone 8–12 nmol/L with elevated SHBG and low calculated free testosterone

Contraindications to TRT

Prostate cancer (active or untreated) — TRT is not contraindicated after definitive treatment with undetectable PSA for >1 year in select cases
Breast cancer in men
Haematocrit >54% (polycythaemia)
Severe untreated obstructive sleep apnoea
Uncontrolled heart failure (NYHA class IV)
Desire for fertility — TRT suppresses spermatogenesis (use clomiphene or hCG instead)

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Testosterone Undecanoate IM

Nebido® / Reandron® 1000 mg/4 mL

Adult dose 1000 mg IM deep gluteal injection; loading at 0, 6, and 12 weeks, then every 10–14 weeks (adjusted by trough levels)

Advantage Long-acting; stable levels; most physiologically preferred depot in Australia

Key monitoring Testosterone trough, PSA, FBC (haematocrit), lipids, LFTs at 3, 6, and 12 months, then annually

PBS status ⚠ PBS Authority Required — requires documented hypogonadism with appropriate investigations

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Testosterone Undecanoate Oral

Andriol® 40 mg capsules

Adult dose 120–160 mg PO daily in 2 divided doses with food (fat-dependent absorption)

Advantage Oral option; self-administration; shorter half-life allows quick cessation if side effects

Disadvantage Variable absorption; less stable serum levels; less commonly used as first-line

PBS status ⚠ PBS Authority Required

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Testosterone 1% Gel

Testogel® 50 mg sachets · Topical

Adult dose 50 mg (1 sachet) applied to shoulders/upper arms daily; titrate to 100 mg based on levels

Advantage Steady-state levels; self-applied; avoid injection visits

Key caution Risk of transdermal transfer to partners/children — cover application site, wash hands, avoid skin contact for ≥6 hours

PBS status ⚠ PBS Authority Required

TRT Monitoring Protocol

Test	Timing	Target / Threshold
Serum testosterone (trough)	3, 6, 12 months, then annually	Mid-normal range (12–20 nmol/L)
PSA + digital rectal exam	3–6 months, 12 months, then annually	PSA rise >1.4 ng/mL in 12 months or PSA >4.0 → urology referral
FBC — Haematocrit	3–6 months, 12 months, then annually	Haematocrit >54% → reduce dose / increase interval / consider venesection
Lipids, LFTs	Baseline and annually	Monitor trends; hepatic dysfunction uncommon with modern formulations

Male Low Libido

Low sexual desire in men is frequently multifactorial and may be under-recognised. In addition to the hormonal and medication causes described above, consider:

Depression (PHQ-9 screening) — up to 60% of men with depression report reduced libido.
Chronic illness: renal failure (uraemic hypogonadism), liver cirrhosis, COPD, heart failure.
Opioid-induced hypogonadism — affects up to 90% of men on long-term opioid therapy; consider testosterone level monitoring and dose reduction where possible.
Relationship dissatisfaction — often the primary driver; consider couples-based intervention.
Alcohol excess — both acute intoxication and chronic alcohol dependence suppress testosterone.

Premature Ejaculation (PE)

PE is the most common male ejaculatory disorder, affecting approximately 15% of Australian men. The ISSM (International Society for Sexual Medicine) definition requires: ejaculation that always or nearly always occurs within ~1 minute of vaginal penetration (lifelong PE) or a clinically significant reduction in latency (often <3 minutes for acquired PE), inability to delay ejaculation, and negative personal consequences.

Management of PE

Psychoeducation & Behavioural

Stop-start technique, squeeze technique, sensate focus. Address performance anxiety. Pelvic floor exercises (Kegels) — evidence supports improved ejaculatory control.

Topical Anaesthetic

Lidocaine-prilocaine cream (Emla®) or lidocaine spray (Fortacin®) applied to glans penis 15–20 minutes before intercourse, washed off before penetration. Simple, effective, low side-effect profile.

Pharmacotherapy

Dapoxetine (Priligy®) 30–60 mg PO 1–3 hours before intercourse — the only TGA-approved oral treatment for PE in Australia. Off-label: daily SSRI (paroxetine 20–40 mg is most effective, sertraline 50–200 mg, or citalopram 20–40 mg).

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Dapoxetine

Priligy® · Short-acting SSRI

Adult dose 30 mg PO 1–3 hours before sexual activity; increase to 60 mg if inadequate response and tolerated

Max frequency Once per 24 hours

Key side effects Nausea (most common, ~20%), dizziness, headache, syncope — advise adequate hydration, avoid alcohol

Cautions Contraindicated with MAOIs, other SSRIs, moderate-strong CYP3A4 inhibitors; cardiac disease (history of syncope, significant valvular disease) → cardiology review before prescribing

PBS status ✘ Not PBS listed (private prescription; ~–50 for 3 tablets)

Special Populations

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Pregnancy & Postpartum

Libido changes: Variable — some women report increased desire in the 2nd trimester; most experience reduced desire in the 3rd trimester and postpartum period due to hormonal shifts, fatigue, body image concerns, and perineal trauma.

Postpartum dyspareunia: Affects up to 60% of women at 3 months postpartum. Perineal trauma (episiotomy, 2nd/3rd/4th degree tears) is the most common cause. Recommend pelvic floor physiotherapy, vaginal oestrogen if breastfeeding (not contraindicated at vaginal doses), and adequate lubrication.

Breastfeeding: Physiological hypo-oestrogenism and reduced vaginal lubrication are normal. Water-based lubricants are recommended; vaginal oestrogen can be used cautiously.

Medications: PDE5 inhibitors, testosterone, and flibanserin are all contraindicated in pregnancy and breastfeeding. Psychosexual counselling is the safest intervention.

MBS note: Antenatal consultation items (items 16500–16502) may cover sexual health discussions as part of routine pregnancy care.

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Paediatric & Adolescent

Adolescent sexual health: Focus on STI prevention (chlamydia is the most commonly notifiable STI in Australians aged 15–29), contraception, consent, and healthy relationships. Offer confidential consultations consistent with the mature minor doctrine (Gillick competence).

Gender diverse youth: Sexual concerns may relate to gender dysphoria, effects of puberty blockers, or cross-sex hormones. Referral to a specialist gender service is recommended.

Disability: Young people with intellectual or physical disability have the right to sexual health information and support. Adapt communication strategies and involve carers appropriately.

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Older Adults

Key principle: Sexual function does not cease at any age. The ASHR2 study found that 54% of Australians aged 70+ reported being sexually active. Do not assume disinterest based on age.

Common barriers: Partner loss, chronic disease polypharmacy, osteoarthritis limiting mobility, pelvic floor weakness, vaginal atrophy, and ageism from healthcare providers.

Medication considerations: PDE5 inhibitors require dose adjustment in renal impairment and hepatic impairment; avoid nitrates. Testosterone replacement requires prostate monitoring (PSA at baseline and follow-up). Consider drug-drug interactions in the context of polypharmacy.

Falls risk: Syncope with dapoxetine; postural hypotension with PDE5 inhibitors — counsel on positional changes and ensure cardiovascular stability.

STI awareness: Rates of chlamydia, gonorrhoea, and syphilis are increasing in Australians aged 60+, particularly in the context of new relationships post-separation or widowhood and use of ED medications. Routine STI screening should be considered.

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Renal Impairment

Prevalence: Sexual dysfunction affects 50–80% of patients with CKD stages 4–5 and >70% of dialysis patients. Aetiology is multifactorial: uraemic hypogonadism, hyperprolactinaemia, anaemia, autonomic neuropathy, medication side effects, depression.

Testosterone: Uraemic hypogonadism is common; testosterone replacement may improve libido and energy but does not reliably improve erectile function in dialysis patients. Monitor haematocrit closely (polycythaemia risk).

PDE5 inhibitors: Dose reduction required (see drug cards above). Sildenafil 25 mg and tadalafil 5 mg (PRN) or 2.5 mg (daily) as starting doses if eGFR <30.

🛡️

Immunocompromised

HIV: Sexual dysfunction is highly prevalent (up to 60%); multifactorial — HIV itself, antiretroviral side effects (especially efavirenz), depression, stigma. Refer to sexual health physician with HIV expertise.

Transplant recipients: Immunosuppressive medications (tacrolimus, cyclosporine, sirolimus) may cause or worsen ED. Fertility concerns are significant — counsel regarding contraception (immunosuppressants are teratogenic) and fertility preservation.

Cancer survivors: Pelvic radiotherapy causes progressive vaginal stenosis (women) and vascular ED (men). Proactive vaginal dilator therapy and pelvic floor physiotherapy should be commenced early. Testicular cancer survivors may have impaired spermatogenesis — fertility counselling pre-treatment is essential.

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Hepatic Impairment

Impact: Cirrhosis causes hypogonadism via SHBG elevation, peripheral aromatisation of testosterone to oestradiol, and direct testicular atrophy (alcoholic cirrhosis).

PDE5 inhibitors: Avoid or use with caution in severe hepatic impairment (Child-Pugh C). Sildenafil dose should be reduced; tadalafil has not been studied in severe hepatic impairment — avoid.

Testosterone: Oral testosterone undecanoate is contraindicated in severe hepatic failure. IM formulations may be used cautiously with LFT monitoring.

Investigations

Investigations should be guided by the clinical presentation and suspected aetiology. The following table summarises the recommended workup for common sexual dysfunction presentations in Australian general practice.

Essential Fasting glucose / HbA1c Screen for diabetes (strongest modifiable risk factor for ED). Available in all pathology laboratories.

Essential Fasting lipid profile Cardiovascular risk stratification in men with ED. Part of absolute CVD risk assessment (Australian CVD Risk Calculator).

Essential Serum testosterone (total) Fasting, morning sample (8–10 am). If 8–12 nmol/L ("grey zone"), proceed to free testosterone. MBS item 66801.

Available Free testosterone (calculated or equilibrium dialysis) When total testosterone is borderline; requires SHBG and albumin for calculation (Vermeulen equation). MBS item 66802.

Available TSH Screen for hypo/hyperthyroidism — reversible cause of both male and female sexual dysfunction. MBS item 66716.

Available Prolactin If testosterone is low or galactorrhoea present. Elevated prolactin may indicate prolactinoma — MRI pituitary if >1000 mIU/L.

Available SHBG Essential for calculating free testosterone. Also elevated by hepatic disease, oestrogen, hyperthyroidism, and some medications.

Available PSA Baseline before commencing testosterone replacement in men; monitor per protocol (3–6 months, then annually). MBS item 66655.

Available FSH / LH / Oestradiol For women with suspected premature ovarian insufficiency, perimenopausal assessment, or evaluating causes of anovulation. MBS items 66670/66671/66672.

Available Pelvic ultrasound For women with deep dyspareunia — assess for endometriomas, adenomyosis, fibroids, adnexal pathology. Transvaginal preferred. MBS item 55066.

Specialist Penile Doppler ultrasound For refractory ED — assesses cavernosal arterial flow and veno-occlusive function. Requires andrology or urology referral.

Specialist Nocturnal penile tumescence (NPT) Differentiates psychogenic from organic ED. Rarely performed; largely replaced by clinical assessment and SHIM scores.

Specialist MRI pituitary If hypogonadotrophic hypogonadism confirmed (low testosterone + low/normal LH/FSH) with elevated prolactin — exclude pituitary macroadenoma.

Monitoring

Ongoing monitoring is essential for patients on pharmacotherapy for sexual dysfunction. The following schedule provides a general framework; individualise based on treatment, comorbidities, and patient preference.

Baseline

Before starting treatment: SHIM/IIEF (men) or FSFI (women) to document severity. Hormonal panel (testosterone, TSH, prolactin as indicated). PSA + DRE before TRT. FBC, LFTs, lipids, HbA1c. Cardiovascular risk assessment in men with ED. Document medication review findings.

4–6 weeks

Early follow-up: Assess response to PDE5 inhibitor or other intervention. Reinforce adequate trial (≥6 attempts). Review side effects. Reassess SHIM/IIEF score.

3 months

TRT monitoring (if applicable): Serum testosterone trough, FBC (haematocrit), PSA. If on PDE5 inhibitor — titrate dose or switch agent if inadequate response. Reassess contributing factors (depression, relationship, medication changes).

6 months

Continued TRT monitoring: Testosterone, PSA, FBC, LFTs. Testosterone in women (if on off-label AndroFeme). Reassess sexual function scores (SHIM/IIEF/FSFI). Consider specialist referral if refractory.

12 months & annually

Long-term follow-up: Annual testosterone, PSA, FBC, LFTs for patients on TRT. Reassess need for continued PDE5 inhibitor therapy. Review cardiovascular risk factors. Update sexual function questionnaire scores. Address any new relationship or psychological concerns.

ℹ️

MBS items for follow-up: Standard consultation items (items 3, 23, 36) apply. Where a GP Management Plan (item 721) or Team Care Arrangement (item 723) exists, allied health referrals (pelvic floor physiotherapy, psychology) may attract Medicare rebates under CDM items (10950–10970).

Aboriginal and Torres Strait Islander Health Considerations

Aboriginal and Torres Strait Islander Health

Cultural safety

Sexual health is a sensitive topic in many Aboriginal and Torres Strait Islander communities. Shame, embarrassment, and cultural taboos around discussing sexual function are significant barriers. GPs must approach with humility, build trust over multiple consultations, and ensure the patient feels safe. Use plain language and avoid clinical jargon. Where possible, involve Aboriginal and Torres Strait Islander health workers (A&TSIHWs) who can provide culturally appropriate support and health promotion.

Remote & rural access

Many Aboriginal and Torres Strait Islander Australians live in remote and very remote areas (17% vs 2% of non-Indigenous Australians — AIHW 2023). Access to specialist sexual health services (urologists, gynaecologists, endocrinologists, psychosexual therapists) is extremely limited. Telehealth (MBS items 91790, 91801, 91802) is an essential modality for specialist consultations. Pharmacy access to PDE5 inhibitors and hormonal therapies may be delayed in remote communities — coordinate with Remote Area Aboriginal Health Services (RAAHS) and the Remote Area Aboriginal Health Supply (RAAHS) programme.

STI burden

Aboriginal and Torres Strait Islander Australians experience significantly higher rates of chlamydia (3x), gonorrhoea (6x), syphilis (6x), and HIV (1.5x) compared with non-Indigenous Australians (Kirby Institute, 2023). The ongoing syphilis outbreak (since 2014) disproportionately affects young Aboriginal and Torres Strait Islander people in northern and central Australia. Sexual dysfunction presentations may coexist with undiagnosed STIs — routine screening (chlamydia, gonorrhoea, syphilis, HIV) should be offered as part of any sexual health consultation.

Social determinants

Sexual dysfunction in Aboriginal and Torres Strait Islander communities is frequently interwoven with broader social determinants: intergenerational trauma (including Stolen Generations), family and domestic violence, incarceration, substance use (alcohol, cannabis, methamphetamines), housing insecurity, and grief and loss. A trauma-informed approach is essential. Referral to social and emotional wellbeing services (e.g., Aboriginal Community Controlled Health Organisations — ACCHOs) should be considered alongside clinical management.

Gendered considerations

In some communities, discussing sexual function with a practitioner of the opposite gender may cause significant discomfort. Where possible, offer the option of seeing an Aboriginal health practitioner or same-sex practitioner. For men's business and women's business consultations, consult with the local Aboriginal health team about culturally appropriate processes. Men's health and women's health days/groups run by ACCHOs provide valuable opportunities for health promotion.

Medication access

Under the Closing the Gap PBS Co-Payment Programme, Aboriginal and Torres Strait Islander Australians with, or at risk of, a chronic disease can access PBS medicines at a reduced co-payment (.70 per script as of 2024) regardless of concession status. This significantly improves access to PDE5 inhibitors, vaginal oestrogen, and other PBS-listed medications for sexual dysfunction. Register patients for the CTG PBS Co-Payment at the time of prescribing.

📚 References

1. Richters J, Grullick AE, de Visser RO, et al. The Second Australian Study of Health and Relationships (ASHR2): Methods and Sample Characteristics. Sexual Health. 2014;11(5):409–419.
2. De Visser RO, Smith AMA, Rissel CE, Richters J, Grullick AE. Sex in Australia: Experiences of sexual distress among a representative sample of adults. Australian and New Zealand Journal of Public Health. 2003;27(2):168–172.
3. Australasian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). Australian STI Management Guidelines for Use in Primary Care. 2023. Available at: https://sti.guidelines.org.au/
4. Endocrine Society of Australia (ESA). Position Statement on Testosterone Replacement Therapy in Adult Men. 2020. Prepared by Grossmann M, Ng Tang Fui M, Cheung AS.
5. Australasian Menopause Society (AMS). Vaginal Oestrogen and Hormone Therapy: Position Statement. 2023.
6. McCool ME, Zuelke A, Theurich MA, Knuettel H, Ricci C, Apfelbacher C. Prevalence of Female Sexual Dysfunction Among Premenopausal Women: A Systematic Review and Meta-Analysis of Observational Studies. Sexual Medicine Reviews. 2016;4(3):197–212.
7. Corona G, Isidori AM, Aversa A, et al. Endocrinological control of men's sexuality: hormones, sexual dysfunction and pharmacological interventions. Endocrine. 2023;82:1–16.
8. Australian Institute of Health and Welfare (AIHW). Aboriginal and Torres Strait Islander Health Performance Framework: Sexual and Reproductive Health. 2023.
9. Kirby Institute. HIV, Viral Hepatitis and Sexually Transmissible Infections in Australia: Annual Surveillance Report 2023. Sydney: Kirby Institute, UNSW Sydney.
10. Hatzimouratidis K, Amar E, Eardley I, et al. Guidelines on Male Sexual Dysfunction: Erectile Dysfunction and Premature Ejaculation. European Urology. 2010;57(5):804–814.
11. Annon JS. The PLISSIT model: A proposed conceptual scheme for the behavioral treatment of sexual problems. Journal of Sex Education and Therapy. 1976;2(1):1–15.
12. Australian Government Department of Health and Aged Care. Fifth National Aboriginal and Torres Strait Islander Blood-Borne Viruses and Sexually Transmissible Infections Strategy 2018–2022. Commonwealth of Australia; 2018.
13. Goldstein I, Kim NN, Clayton AH, et al. Genitourinary Syndrome of Menopause: New Terminology for Vulvovaginal Atrophy from the International Society for the Study of Women's Sexual Health (ISSWSH) and The North American Menopause Society (NAMS). Menopause. 2014;21(10):1063–1068.
14. Royal Australian College of General Practitioners (RACGP). Sexual Health and Genital Medicine in General Practice. 4th ed. Melbourne: RACGP; 2020.
15. Basson R, Wierman ME, van Lankveld J, Brotto L. Summary of the Recommendations on Sexual Dysfunctions in Women. Journal of Sexual Medicine. 2010;7(1 Pt 2):314–326.

for PBS scripts. Utilise ACCHS pharmacies and Remote Area Aboriginal Health Worker programs for medication supply in remote areas. Avoid initiating benzodiazepines; support holistic pain management including community-based exercise programs.

Preventive health

Promote bone health: encourage vitamin D supplementation (1000 IU daily in deficient individuals), smoking cessation support, reduction of alcohol intake, and weight-bearing exercise. MBS Item 715 health checks provide a structured opportunity to assess bone health, screen for osteoporosis risk factors, and discuss musculoskeletal health in a culturally safe context.

Quick Reference: Differential Diagnosis at a Glance

Costovertebral dysfunction

Paracetamol ± NSAID; manual therapy

2–6 weeks

Provocable on palpation; no red flags

Thoracic compression fracture

Paracetamol; ± calcitonin; DXA + osteoporosis Rx

6–12 weeks healing

Elderly; osteoporosis; acute onset

ACS (posterior MI)

Aspirin 300 mg, GTN, heparin; urgent PCI

Time-critical

ECG, troponin; CV risk factors

Aortic dissection

IV labetalol; urgent CT aortogram; surgery (Type A)

Time-critical

Tearing pain; BP differential >20 mmHg

Vertebral osteomyelitis

IV antibiotics (vancomycin + ceftriaxone initially); ID consult

6 weeks IV antibiotics

Fever, elevated CRP, IV drug use

Biliary colic / cholecystitis

Paracetamol ± morphine; lap cholecystectomy

Surgical within 72 h (cholecystitis)

RUQ/infrascapular; post-prandial; RUQ US

📚 References

1. Briggs AM, Smith AJ, Straker LM, Bragge P. Thoracic spine pain in the general population: prevalence, incidence and associated factors in children, adolescents and adults. A systematic review. BMC Musculoskelet Disord. 2009;10:77.
2. National Health and Medical Research Council (NHMRC). Evidence-based management of acute musculoskeletal pain. Canberra: NHMRC; 2003 (updated 2020).
3. Australian Institute of Health and Welfare (AIHW). Aboriginal and Torres Strait Islander Health Performance Framework: Summary report 2023. Canberra: AIHW; 2023.
4. Deyo RA, Rainville J, Kent DL. What can the history and physical examination tell us about low back pain? JAMA. 1992;268(6):760–765.
5. Stochkendahl MJ, Kjaer P, Hartvigsen J, et al. National Clinical Guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Europ Spine J. 2018;27(1):60–75.
6. Erwin WM, Jackson PC, Homonko DA. Innervation of the human costovertebral joint: implications for clinical back pain syndromes. J Manipulative Physiol Ther. 2000;23(6):395–403.
7. Royal Australian College of General Practitioners (RACGP). Guidelines for preventive activities in general practice. 9th edn. Melbourne: RACGP; 2018 (updated 2023).
8. Hirsch JA, Singh V, Falco FJE, et al. Thoracic facet joint interventions. Pain Physician. 2016;19(4):E581–E593.
9. Erwin WM, Jackson PC. The costovertebral joint: anatomy, biomechanics, and clinical significance in thoracic back pain syndromes. J Can Chiropr Assoc. 2003;47(2):112–120.
10. Strayer RJ, Gunnerson JM, Brown LH, et al. Aortic dissection: clinical features, diagnosis, and management. Aust Crit Care. 2019;32(2):144–153.
11. Ombregt L. A system of orthopaedic medicine. 3rd edn. Edinburgh: Churchill Livingstone Elsevier; 2013. Chapter 18: Thoracic spine.
12. Lin CC, Chen KH, Li DM, et al. Characteristics and outcomes of patients presenting with thoracic back pain to the emergency department. Emerg Med Australas. 2020;32(5):805–811.

for PBS-listed medicines at participating pharmacies.

Cultural safety

Engagement with Aboriginal Community Controlled Health Organisations (ACCHOs) is essential. Cultural safety training for non-Indigenous clinicians, use of Aboriginal Health Workers and Liaison Officers, and incorporation of traditional healing practices alongside Western medicine improve treatment adherence and outcomes. Avoidance of eye contact, respect for gender-sensitive examination practices, and understanding of sorry business protocols are critical elements of culturally safe care.

Medication adherence

Complex DMARD regimens with frequent monitoring requirements present adherence challenges. Long-acting depot injections (e.g., methotrexate SC) may improve adherence compared to oral regimens. Community pharmacy partnerships through the Indigenous Pharmacy Programmes improve medication management.

Specific conditions

Rheumatic heart disease (RHD) requires secondary prophylaxis with benzathine penicillin G (BPG) 1.2 MU IM every 3–4 weeks for a minimum of 10 years or until age 21 (whichever is longer). RHD registers (e.g., NT RHD Register) facilitate recall and follow-up. The Australian RHD Endgame Strategy targets elimination by 2031.

Referral pathways

Referral through ACCHOs and Aboriginal Hospital Liaison Officers (AHLOs) improves engagement. The Specialist Outreach Assistance Programme provides funded specialist visits to remote communities. NT, WA, and QLD have specific rheumatology outreach programmes targeting Indigenous communities.

📚 References

1. Australian Institute of Health and Welfare (AIHW). Autoimmune disease in Australia. Cat. no. PHE 312. Canberra: AIHW; 2023.
2. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2021;73(7):924–939.
3. Fanouriakis A, Kostopoulou M, Alber K, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019;78(6):736–745.
4. Chung SA, Langford CA, Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Care Res. 2021;73(11):1583–1599.
5. Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3–18.
6. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook. Australian Government Department of Health; 2024. Available from: immunisationhandbook.health.gov.au.
7. Rheumatic Heart Disease Australia (RHDAustralia). The 2020 Australian guideline for prevention, diagnosis, and management of acute rheumatic fever and rheumatic heart disease. 3rd ed. Darwin: Menzies School of Health Research; 2020.
8. Pharmaceutical Benefits Scheme (PBS). PBS Schedule. Australian Government Department of Health. Available from: pbs.gov.au. Accessed 2024.
9. Agarwal S, Cunnington J, Nossent J. Autoimmune disease in Indigenous Australians: a systematic review. Int J Rheum Dis. 2021;24(12):1487–1498.
10. Pisetsky DS. Antinuclear antibody testing — misunderstood or misused? Clin Immunol. 2023;255:109717.
11. Bertsias GK, Tektonidou M, Amoura Z, et al. Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012;71(11):1771–1782.
12. Ledingham J, Deighton C; British Society for Rheumatology Standards, Audit and Guidelines Working Group. Update on the British Society for Rheumatology guidelines for prescribing TNFα blockers in adults with rheumatoid arthritis. Rheumatology. 2005;44(2):155–158.
13. National Health and Medical Research Council (NHMRC). National statement on ethical conduct in human research. Canberra: NHMRC; 2023 (updated).

for PBS-listed medicines at participating pharmacies.

Cultural safety

Medication adherence

Specific conditions

Referral pathways

📚 References

1. Australian Institute of Health and Welfare (AIHW). Autoimmune disease in Australia. Cat. no. PHE 312. Canberra: AIHW; 2023.
2. Fraenkel L, Bathon JM, England BR, et al. 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis. Arthritis Care Res. 2021;73(7):924–939.
3. Fanouriakis A, Kostopoulou M, Alber K, et al. 2019 update of the EULAR recommendations for the management of systemic lupus erythematosus. Ann Rheum Dis. 2019;78(6):736–745.
4. Chung SA, Langford CA, Maz M, et al. 2021 American College of Rheumatology/Vasculitis Foundation guideline for the management of antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Care Res. 2021;73(11):1583–1599.
5. Smolen JS, Landewé RBM, Bijlsma JWJ, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2022 update. Ann Rheum Dis. 2023;82(1):3–18.
6. Australian Technical Advisory Group on Immunisation (ATAGI). Australian Immunisation Handbook. Australian Government Department of Health; 2024. Available from: immunisationhandbook.health.gov.au.
7. Rheumatic Heart Disease Australia (RHDAustralia). The 2020 Australian guideline for prevention, diagnosis, and management of acute rheumatic fever and rheumatic heart disease. 3rd ed. Darwin: Menzies School of Health Research; 2020.
8. Pharmaceutical Benefits Scheme (PBS). PBS Schedule. Australian Government Department of Health. Available from: pbs.gov.au. Accessed 2024.
9. Agarwal S, Cunnington J, Nossent J. Autoimmune disease in Indigenous Australians: a systematic review. Int J Rheum Dis. 2021;24(12):1487–1498.
10. Pisetsky DS. Antinuclear antibody testing — misunderstood or misused? Clin Immunol. 2023;255:109717.
11. Bertsias GK, Tektonidou M, Amoura Z, et al. Joint European League Against Rheumatism and European Renal Association–European Dialysis and Transplant Association (EULAR/ERA-EDTA) recommendations for the management of adult and paediatric lupus nephritis. Ann Rheum Dis. 2012;71(11):1771–1782.
12. Ledingham J, Deighton C; British Society for Rheumatology Standards, Audit and Guidelines Working Group. Update on the British Society for Rheumatology guidelines for prescribing TNFα blockers in adults with rheumatoid arthritis. Rheumatology. 2005;44(2):155–158.
13. National Health and Medical Research Council (NHMRC). National statement on ethical conduct in human research. Canberra: NHMRC; 2023 (updated).