 Oct. 17, 2002 |
| ASSEMBLY EDITION • SAN DIEGO |
Bob Dole may have been the first person to discuss erectile dysfunction openly on TV, but family physicians are the ones who need to talk openly and routinely about sexual activity and sexual dysfunction with their patients in everyday practice.
Many patients, especially men, rarely initiate clinical conversations about such sexual concerns as low libido, arousal difficulties, and problems with early ejaculation or lack of orgasm. But studies show that most patients want to talk about these problems with their physicians. Satisfying sexual activity, it has been shown, enhances quality of life and self-esteem.
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"Family physicians need to
be proactive in discussing sex. Ask your patients if they are enjoying sex and
if it is satisfying to them." |
In a clinical seminar titled "Sexual Dysfunction in Adults" held twice yesterday and to be given again today from 4 to 6 p.m., two expert speakers explained to attendees how to initiate discussions of sexual activity, screen for dysfunction and manage patients with sexual difficulties, both physical and psychosocial.
"Family physicians need to be proactive in discussing sex. Ask your patients if they are enjoying sex and if it is satisfying to them," advised speaker Richard Sadovsky, M.D., associate professor of family practice at the State University of New York Health Science-Downstate Medical Center, Brooklyn. "Satisfying sexual activity can enhance relationships, and good relationships are good for overall health."
Sadovsky said that sexual dysfunction may provide family physicians with a clue to associated medical problems, such as endothelial dysfunction in the form of coronary artery disease. Some types of sexual dysfunction, especially erectile dysfunction, are associated with depression.
A common complaint
Sexual dysfunction is common in men and women, Sadovsky said. About 31 percent of men have some form of sexual dysfunction. The most common complaint is premature ejaculation (21 percent), followed by erectile dysfunction and low sex drive.
Approximately 43 percent of women suffer sexual dysfunction, including low sex drive (33 percent), orgasmic dysfunction, lubrication issues and pain.
According to speaker Margaret Nusbaum, D.O., M.P.H., associate professor of family medicine and co-director of the family medicine residency program at the University of North Carolina, Chapel Hill, screening patients for sexual health is an important part of history-taking. "If the patient has a sexual problem, ask if it has been a lifelong problem or recently acquired and if it is situational or generalized," she said.
The major causes of sexual dysfunction include comorbidities, such as cardiovascular disease, diabetes and cancer; psychotropic medications for depression and anxiety; antihypertensive medications; hypogonadism; and alcohol abuse, the speakers noted. Low libido may be associated with psychosocial issues, such as misconceptions about sex, cultural or religious taboos, relationship issues, and loss of job or income.
Management
FPs should advise patients that improved communication between sexual partners about their needs and difficulties will likely improve sexual satisfaction and resolve some problems, Nusbaum and Sadovsky said. Healthy lifestyle choices, especially exercise, will also improve sexual function. Women can perform pubococcygeal muscle exercises to improve sexual response.
The Food and Drug Administration has approved the use of sildenafil for erectile dysfunction in men. Early ejaculation may be treated with clomipramine, sertraline, fluoxetine or paroxetine. For arousal difficulties in women, androgens and lubricants are useful. Hormone replacement (DHEAS, testosterone and estrogens), sildenafil and dopaminergic agents may be prescribed for decreased sexual interest in women.
FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.