Frequency and Focus of Sexual History Taking in Male Patients—A Pilot Study Conducted among Swiss General Practitioners and Urologists (original) (raw)
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The Journal of Sexual Medicine, 2008
Introduction. General practitioners (GPs) and urologists are the first medical contacts for men with sexual dysfunction. Previous studies have shown that many GPs hesitate to address sexual issues and little is known about the sexological skills of urologists. Aim. To analyze sexual history taking (SHT) by Swiss GPs and urologists, in terms of active exploration, focus, and competence in discussing and treating sexual dysfunction. Methods. A semi-structured interview was developed and used in face-to-face encounters with 25 GPs and 25 urologists. Main Outcome Measures. Content and frequency of interview responses. Results. Urologists reported a significantly higher frequency of actively asking male patients about sexual dysfunction (22.80% vs. 10.42%, P = 0.01). GPs and urologists avoided actively asking certain patient groups about sexual dysfunction (e.g., "immigrants," "macho men"). GPs reported a significantly lower percentage of male patients who spontaneously address sexual problems (6.35% vs. 18.40%, P < 0.001). Both physician groups emphasized erectile dysfunction in SHT. Eight percent of GPs and 28% of urologists considered their competence in discussing sexual dysfunction as very good. No GP and 20% of urologists considered their competence in treating sexual dysfunction as very good. Urologists reported having significantly greater competence in discussing (P = 0.02) and treating (P < 0.001) sexual dysfunction than the GPs. Competence in discussing correlated positively with competence in treating sexual dysfunction for GPs (P = 0.01) and urologists (P < 0.001). The majority of GPs (92%) and urologists (76%) reported a need for continuing education in sexual issues. Conclusions. Our results justify establishing guidelines for SHT in Switzerland to better meet the sexual health needs of male patients. Physicians should be encouraged to routinely inquire about sexual issues, overcome their discomfort with the subject, and regard male sexuality as more than erectile function. A clear need exists for relevant continuing education for Swiss GPs and urologists. Platano G, Margraf J, Alder J, and Bitzer J. Frequency and focus of sexual history taking in male patients-A pilot study conducted among Swiss general practitioners and urologists.
Journal of Sexual Medicine, 2008
Male sexual dysfunction is a common medical condition, which is addressed mainly from a biomedical perspective by Swiss general practitioners (GPs) and urologists as the results of part I of our study showed. A psychosocial orientation in sexual history taking (SHT) leads to a truly patient-centered approach and is crucial for improving therapy decisions related to sexual dysfunction. Aim. To analyze to what extent Swiss GPs and urologists have a psychosocial orientation in SHT, and what therapeutic options they focus on when confronted with male sexual dysfunction. Methods. A semistructured interview was developed and used in face-to-face encounters with 25 GPs and 25 urologists. Main Outcome Measures. Content and frequency of interview responses. Results. The GPs and urologists differed significantly from each other in 5 out of 22 psychosocial factors. Summarizing these psychosocial factors in four domains showed a difference between the GPs and urologists in only one domain. Both groups focus on an open conversation as their approach in SHT. No GP and only a minority of urologists based their diagnosis on criteria of the International Classification of Diseases (10th edition) (ICD-10) or Diagnostic and Statistical Manual of Mental Disorders (4th edition) (DSM-IV). The GPs and urologists differed significantly from each other in 4 out of 16 combinations resulting from the given therapeutic options and form of sexual dysfunction. The urologists focus more strongly on medication as a therapeutic option.
Talking about sexuality with the physician: are patients receiving what they wish?
Swiss Medical Weekly, 2011
QUESTIONS UNDER STUDY/PRINCIPLES: Little is known concerning patients' expectations regarding sexual history taking by doctors: to ascertain expectations and actual experience of talking about sexuality among male patients attending outpatient clinics, and their sexual behaviour. METHODS: Patients consecutively recruited from two outpatient clinics in Lausanne, Switzerland were provided with an anonymous self-administered questionnaire. Survey topics were: patients' expectations concerning sexual history taking, patients' lifetime experience of sexual history taking, and patients' sexual behaviour. RESULTS: The response rate was 53.0% (N = 1452). Among respondents, 90.9% would like their physician to ask them questions regarding their sexual history in order to receive advice on prevention (60.0% yes, 30.9% rather yes). Fifteen percent would be embarrassed or rather embarrassed if asked such questions. Nevertheless, 76.2% of these individuals would like their physician to do so. Despite these wishes, only 40.5% reported ever having a discussion "on their sexual life in general" with a doctor. Only one patient out of four to five was asked about previous sexually transmitted infections (STIs), the number of sexual partners and their sexual orientation. No feature of their sexual life distinguishes those who had discussed sexual issues with a doctor from those who had not, except a history of previous consultation for health problems related to sexuality. Conversely, being embarrassed about conducting this discussion was significantly associated with lack of discussion regarding sexuality. CONCLUSIONS: This study highlights the gap existing in the field of STI prevention in terms of doctors' advice and patients' wishes.
Progrès en Urologie, 2020
Erectile dysfunction varied by country, affecting between 20 to 40% of men aged 60 and 69 and more than 50% of men aged over 75. Our objective was to evaluate the habits of urologists in 2018 and also evaluate the need for additional, objective tools to aid physicians when providing care. A questionnaire was sent from the French Urology Association to 1158 physicians between November and December 2018. In all, 177 urologists (15.28%) took part in the study. Only 22% of urologists regularly used a questionnaire, such as the IIEF-5. When faced with erection problems, 56.5% of them did not carry out systematic cardiology evaluations. More than half of urologists requested fasting glucose, lipid and total testosterone levels. Twenty-seven percent did not carry out additional tests. First line treatment included a phosphodiesterase 5 inhibitor in 81% of cases. Two thirds of urologists (78%) rated themselves as being correctly trained in the area of erectile dysfunction. However, only 49% systematically inquired about erection problems when faced with benign prostatic hyperplasia and 65% thought that erectile dysfunction was not treated optimally. Despite existing recommendations, only half of urologists carry out a cardiac evaluation when a finding of erectile dysfunction is made. One third of
Recognizing the risk of erectile dysfunction in a urology clinic practice
BJU International, 2005
Information readily obtained through a patient's self-report (that typically obtained in the office setting) can be very useful in understanding and predicting the likelihood of ED. Risk factors identified largely paralleled those identified in men generally, and included age, specific urological and non-urological somatic conditions, and tobacco use. Furthermore, knowing about even moderate levels of patient-reported psychological or relationship stress was useful in assessing the risk of ED. CONCLUSION Understanding the relationship of such risk factors to ED among men visiting a urology clinic might be particularly useful in clinical situations where the patient, for whatever reason, is reluctant to disclose an erectile problem when scheduling an appointment or even during the consultation. KEYWORDS erectile dysfunction, physician-patient communication, age, tobacco use, diabetes mellitus, psychological distress OBJECTIVE To determine the utility of simple patientreported information in signalling erectile dysfunction (ED), as a challenge for the clinical urologist or related specialist is to quickly recognize risk factors for sexual dysfunction within the time constraints of an office visit. PATIENTS AND METHODS In a sample of men visiting a urology clinic, we determined the utility of simple patientreported information in signalling ED.
The Journal of Sexual Medicine, 2012
Evidence shows that sexual dysfunctions (SDs) are very prevalent in both sexes and that they share risk factors with many other conditions. It is known that only a minority of people experiencing sexual problems seek treatment, but the role of the general practitioner (GP) in SD diagnosis and treatment is relatively unexplored. No study has been conducted in Portugal in order to identify GPs' knowledge, attitudes, beliefs, and practices regarding SD and only a small amount of similar studies from other countries have been published. Aim. To characterize GPs' knowledge, attitudes, and beliefs concerning SD; practices of SD management in daily practice; self-perceived competence in discussing and treating SD; and need for training. Methods. Cross-sectional study using confidential self-administered questionnaires applied to GPs working in Primary Health Care Units in the Lisbon region. Main Outcome Measures. The questionnaire collected information concerning GPs' knowledge and perceptions regarding SD, training and practice in sexual health, criteria for initiating discussion and treatment, and the adoption of guidelines. Results. A total of 50 questionnaires (30 females) were obtained (73.5% response rate). On average, the 50 participants were 52 Ϯ 8.6 years old, had 21 Ϯ 8.2 years of family practice, and followed 1,613 Ϯ 364 patients. The degree in medicine was never considered as an extremely adequate source of information both for male and female SD. Lack of time to obtain relevant information for clinical practice and to deal with sexual health issues were perceived as important barriers in initiating a discussion with the patient, as well as lack of academic training and experience in this area. Conclusions. GPs expressed a high need for continuous training in this area and more than half considered that their degree was not an adequate source of training. These results indicate that there is a need for both pregraduate and postgraduate training in this area. Alarcão V,
The Journal of Sexual Medicine, 2007
Introduction. The recent availability of noninvasive pharmacological remedies for male sexual function triggered an exponential increase in the number of men requesting help in the sexuality area. Aim. The Italian Society of Andrology explored requests for help, not included in formerly established clinical categories of sexual medicine. Methods. A central board of 67 andrologists identified new areas of requests for help, instrumental for a web-based questionnaire, forwarded to 912 members of the Italian Society of Andrology. Results were submitted to an independent consensus development panel. Main Outcome Measures. A questionnaire response rate of 30.8% was considered acceptable according to standard response rates of medical specialist samples. Results. The Central Board interaction identified two new domains of requests for help: sexual distress and unconventional requests for pro-erectile medications. Web-based questionnaire results suggested that such domains account for 29% and 9% respectively of all requests for help already presented by male patients at sexual medicine clinics. The Independent Consensus Development Panel issued a final consensus document; herewith, the statement defining male sexual distress: A non-transitory condition and/or feeling of inadequacy such as to impair "sexual health" (WHO working definition). Inadequacy can originate both from physiological modifications of male sexual functions, and from diseases, dysfunctions, dysfunctional symptoms and dysmorphisms, both of andrological and non-andrological origin, which do not relate to "erectile dysfunction" (NIH Consensus Development Panel definition), but that might also induce erectile dysfunction. Sexual Distress can lead to a request for help which needs to be acknowledged. Conclusion. The Italian Society of Andrology identified two new areas of requests for help concerning male sexual issues: sexual distress and unconventional requests for pro-erectile medications. These domains, which do not represent new diseases, nonetheless induce the sufferers to seek help and, accordingly, need to be acknowledged. Pescatori ES, Giammusso B, Piubello G, Gentile V, and Pirozzi Farina F. Journey into the realm of requests for help presented to sexual medicine specialists: Introducing male sexual distress. J Sex Med 2007;4:762-770.
2010
Background Despite the recent focus on sexual behaviour and AIDs, there are almost no data on the prevalence of sexual dysfunction within primary care settings. Method One hundred and seventy patients attending a general practice participated in a questionnaire survey of the prevalence and characteristics of sexual problems. The detection rate of the general practitioners (GPs) and indicators in the patient notes were also investigated. Results Thirty five per cent of the men (n = 22) reported some form of specific sexual dysfunction: premature ejaculation was identified in 31 per cent of the men; 17 per cent experienced erectile dysfunction, which was associated with current medication, a high mean annual attendance and increasing age. The prevalence of sexual dysfunction in the women was 42 per cent {n = 41); vaginismus was reported by 30 per cent of the sample; 23 per cent of the women suffered from anorgasmia. General sexual dissatisfaction was more common than specific dysfunction; 68 per cent (n = 66) of the women and 75 per cent (n = 54) of the men reported at least one problem with dissatisfaction, avoidance, infrequency or non-communication. The large majority of the sample (70 per cent) considered sexual matters to be an appropriate topic for the GP to discuss. Despite this, sexual problems were recorded in only 2 per cent of the GP notes.
Prevalence of Erectile Dysfunction in Urology Consultation: A Prospective Study
International Journal of Advanced Research, 2021
Introduction:Erectile dysfunction is defined by the inability to obtain or maintain an erection sufficient to allow a satisfactory sexual relationship, according to the 2nd International Conference on Sexual Dysfunctions of 2004. This constitutes an attack on virility, and is a source of significant psychological suffering for the individual as well as for his partner. Erectile dysfunction is also a multifactorial disease, related to the overall physical and psychological health of the patient. Materials And Methods: The survey was conducted during three months in the military hospital of Avicenne in Marrakesh. It involved all patients consulting in Urology aged over 18 years regardless of the reason of consultation. Data was collected through a questionnaire by direct interview. The evaluation of ED was based on the definition of the 2nd International Conference of Sexual Dysfunction of 2004. Results: The analysis included 482 patients. The average age of patients was 51 ± 11 year...
BMJ, 2003
Objectives To assess sexual behaviour, prevalence of ICD-10 diagnosed sexual dysfunction, associations between sexual and psychological problems, and help seeking for sexual problems in people attending general practice; to assess predictors of ICD-10 diagnosis of sexual dysfunction. Design Cross sectional study. Setting 13 general practices in London. Participants 1065 women and 447 men attending general practices. Main outcome measure Prevalence and predictors of ICD-10 diagnoses of sexual dysfunction. Results 97 (22%, 95% confidence interval 18% to 25%) men and 422 (40%, 37% to 43%) women received at least one ICD-10 diagnosis, but only 3-4% had an entry relating to sexual problems in their general practice notes. The most common problems were erectile failure and lack or loss of sexual desire in men and lack or loss of sexual desire and failure of orgasmic response in women. Increasing age and being unemployed predicted sexual problems in women, and bisexual orientation, being non-white, and being unemployed were demographic predictors in men. No practice note factors predicted sexual problems in women, but high consulting rate predicted problems in men. The main clinical predictors were poor physical function and dissatisfaction with current sex life in both sexes and higher psychological morbidity in women. When all factors were considered, increasing age (odds ratio 1.01, 1.00 to 1.02), physical subscale score on the SF-12 (0.98, 0.97 to 0.99), sexual dissatisfaction (1.9, 1.5 to 2.4), and scoring over a 3/4 threshold score on the general health questionnaire (1.5, 1.1 to 1.9) independently predicted an ICD-10 sexual dysfunction diagnosis in women. Being bisexual (4.1, 1.3 to 12.8) was the only independent predictor of an ICD-10 diagnosis in men. Conclusions Sexual difficulties are common in people attending general practitioners, and many people are prepared to talk about them with their doctors. Editorial by Ogden See also p 426