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A collaborative brief engagement with medically unexplained sexual and other persistent physical symptoms: a realist service evaluationAttempts to secure improved outcomes with persistent medically unexplained physical symptoms (MUS/PPS) are in their early stages of development and effective implementation in the United Kingdom remains inconsistent. There are scant systematically examined process and outcome studies in this field published in peer reviewed journals. Moreover, persistent sexual symptoms no longer appear in listed examples of MUS/PPS in the professional literature and consequently few studies can be found on 'what works' for improved outcomes with this group of sufferers. A systematic evaluation of an NHS Community Psychosexual Counselling Service delivered within an Integrated Contraception and Sexual Health Service for adults with persistent sexual dysfunction is summarised. The findings from the synthesis of evaluated research, professional guidance and a particular practice, at clinic cohort and embedded case levels, revealed common themes of engagement across the therapy divides when addressing “medically unexplained” physical symptoms. This supports future research in this area and calls for the inclusion of persistent sexual symptoms. The extracted themes from the therapy process may be used as tools to enhance skills of engagement with unresolved PPS in similar settings in which the individual seeks help to achieve improved outcomes.