A sexology expert report arrives on the file. It runs to 20 pages, it contains scores from questionnaires you have not seen before, and it reaches a diagnosis in an area the other medical reports barely touched. Most readers go straight to the opinion on causation and skip the rest. That is a mistake, because the sections in between decide how well the opinion holds up when the other side pushes on it. This article explains how to read a sexology expert report and how to use it in negotiation.
In short
- The history, instruments and limitations sections carry the weight of the opinion. Read them before the conclusions.
- Questionnaire scores support the clinical interview. They do not replace it, and every cutoff has known error rates.
- The strongest negotiating position comes from an opinion that states its baseline, its apportionment and its limits plainly.
- Good instructions produce a report you can use. Vague instructions produce a report you have to chase.
What is the report there to answer?
A sexology expert report answers the questions you put to it. In my practice, reports typically run to 15 to 25 pages and are structured question by question against the instructions. They draw on a structured questionnaire the claimant completes before the interview, validated instruments and peer-reviewed references.
The expert’s duty is to the court or tribunal. In Queensland, the Uniform Civil Procedure Rules state that an expert is not an advocate for a party and must not accept instructions to adopt or reject a particular opinion. The Harmonised Expert Witness Code of Conduct, which the Federal Court requires experts to read and agree to be bound by, sits in Annexure A of its Expert Evidence Practice Note. Other jurisdictions have their own rules and codes, so check the one that applies to your matter.
That duty shapes how you should read the report. An independent opinion will contain findings you do not like. Those findings are usually the most useful part, because they show you where the dispute is likely to be fought.
How to read a sexology expert report section by section
Reports vary in layout. These are the parts I would read closely in any of them.
- Instructions and materials reviewed. Check that the expert saw the records that matter: GP notes, specialist reports, imaging, operative notes, medication lists and any psychological reports. A gap here is where the other side will start.
- History. This sets out sexual function before and after the event. The pre-event baseline is the comparator for everything that follows. Look for how it was established and whether the claimant’s account fits the records.
- Instruments and results. Scores should be reported with the name of the instrument, what it measures and what the cutoffs mean. More on this below.
- Formulation and diagnosis. This is the expert’s reasoned view on whether a sexual health impairment is present, what type it is and how severe. It should say why the diagnosis fits and why other explanations were considered.
- Causation and contribution. Look for a clear account of what the event contributed, what was already there, and what else is in play, such as medication, mood, age, relationship factors or other conditions. Apportionment should be explained in words, not just asserted.
- Prognosis and treatment. The report should say what is likely to improve, over what period, with what treatment, and what is unlikely to change. It should separate treatment that is reasonable and necessary from treatment that is merely possible.
- Partner impact and consent. Where relevant, the report addresses effects on the partner and whether the claimant was told about sexual outcomes before a procedure.
- Assumptions and limitations. A good report says which facts it assumed and what would change the opinion. Treat this section as a map of the cross-examination.
If you want to understand how the information in the history and instruments sections is gathered, my post on what a sexual health independent medical examination involves walks through the assessment itself.
What do the questionnaire scores actually tell you?
Validated instruments give a structured, repeatable measure of what the claimant reports. They are useful and they have limits.
Take the International Index of Erectile Function. It is a self-report measure for male sexual function, and a review in the International Journal of Impotence Research describes it as linguistically validated in 32 languages and used as a primary endpoint in more than 50 clinical trials. A diagnostic evaluation of its erectile function domain proposed a cutoff score of 25 on a scale from 6 to 30 for separating men with and without erectile dysfunction.
For women, the Female Sexual Function Index is widely used. A cross-validation study proposed a total score of 26.55 as the best cutoff. At that cutoff, about 70.7 per cent of women with dysfunction and 88.1 per cent of women without it were correctly classified in the cross-validation sample. So the cutoff misses some women who have a problem. Cutoffs also differ between populations: a Thai study found an optimal cutoff of 23.1 for its sample.
The practical points for a reader are these:
- A score is a self-report over a set recall window. For the FSFI, the recall period is the past four weeks.
- A score above or below a cutoff does not settle the diagnosis. The clinical interview does that work.
- Some instruments suit some claimants better than others. A validation of the German IIEF noted that its focus on partnered sexual activity limits its use.
When a report explains why it chose its instruments and what it did when a score and the interview pointed in different directions, that is a sign of care. When it simply reports a number, ask more questions.
How do you use a sexology expert report in negotiation?
I am a clinician, not a lawyer, so I will stay with what the report can offer and leave strategy to you.
It can narrow the dispute. A report that finds a sexual health impairment and states its severity moves the argument from whether anything is wrong to cause, contribution and consequences. That is a more productive place to negotiate from. Many files never reach that point because sexual function was never assessed. I wrote about why in sexual dysfunction as an overlooked head of damage.
It can anchor treatment. Where the report identifies reasonable and necessary treatment, you have something specific to put to the other side, with a stated purpose and timeframe. Check that the treatment matches the diagnosis and the prognosis.
It tells you what the other side will test. The usual targets are the baseline, the apportionment, the consistency of the history with the records, and the reliance on self-report. If the report already deals with each of these, it is in a stronger position. If it does not, a supplementary question is better asked now than at a hearing.
It should not be pushed to say more or less. Asking an expert to soften or sharpen an opinion undermines its value, and the rules in places like Queensland are clear that experts must not accept instructions to adopt or reject a particular opinion. The Federal Court practice note also says experts should willingly be prepared to change their opinion or make concessions when appropriate. A good expert will move when given new facts and will hold when given only pressure.
It may be tested against other opinions. Courts can direct experts to confer. In Queensland, rule 428 allows a direction that experts hold a conference to identify and try to resolve disagreement, then prepare a joint report. The Federal Court may order concurrent expert evidence. A report written with clear reasoning is easier to defend in either setting.
What should you put in the instructions, and what should you check on receipt?
The quality of the report follows the quality of the instructions. Before you send them:
- Define the questions: presence and nature of impairment, severity, causation and contribution, prognosis, reasonable and necessary treatment, and partner impact if relevant.
- Supply the full records, including pre-event records that show baseline function.
- Identify any other expert reports, so overlaps with urology, neurology, psychiatry or gynaecology are addressed. Where a question belongs to one of those specialties, the sexology report should say so and defer.
- State the jurisdiction and the applicable expert code or practice direction.
- Say whether you need a single, joint or tribunal-appointed expert.
When the report comes back, check:
- Does it answer each question in the order asked?
- Does it state the baseline and how it was established?
- Are instruments named, scored and explained, with references?
- Is apportionment explained rather than asserted?
- Are assumptions and limitations stated?
- Does it include the declarations your jurisdiction requires?
Queensland, for example, requires expert reports to include prescribed content, and the 2022 amendments to the rules are summarised in the explanatory notes. Requirements differ elsewhere, so confirm which rules apply to your matter.
When a report is unclear, ask
If something in the report is unclear, ask a short, specific supplementary question. Reports that cannot answer a plain question about their own reasoning are weaker for it. Reports that can are easier to rely on and easier to settle on.
If you would like to discuss a matter, a complimentary preliminary discussion is available to confirm scope before a formal referral. Instructions are accepted Australia-wide, and the details are on the medico-legal consultancy services page. You can also email info@arianasexology.com.
If it wasn’t assessed, it wasn’t claimed.