In the UK, sexual dysfunction (SD) services within sexual health services (SHS) have historically been subject to geographical variation. Services in many areas have had limited or no budget within service specifications and at times have been viewed as not being part of core SHS business. Recent changes in commissioning arrangements for SHS have resulted in a reduction in the overall budget for SHS provision in many parts of the country. The changes saw commissioning move from centralised National Health Service (NHS) to local authorities taking responsibility for planning, purchasing and monitoring of services for sexual health including HIV prevention and testing but not HIV care and management. Although this resulted in more autonomy about how much and what exactly is funded, after a short hiatus, local authorities began procuring SHS using tender processes. Since these changes, there …