Management of Sexual Problems
Only 12% (34/288) of the respondents had already consulted their family physicians because of sexual problems, and most (23/34) of these patients were satisfied with the physician’s treatment (discussion about the difficulties in 56% of cases, prescription of drugs in 29%, and specialist referral in 24%).
The physicians remembered only a few consultations about sexual problems. On average, they recalled seeing 7 patients every 3 months primarily because of sexual difficulties. In an additional 6 patient contacts, sexual problems were raised during the consultation.
The physicians stated that they initiated discussion about sexual problems only sometimes (53%) or seldom (37%) during the consultation. They considered the following occasions or conditions as good opportunities to start a discussion: psychosomatic complaints (16/19; 84%), family planning (53%), questions concerning human immunodeficiency virus (47%), and diseases, such as diabetes mellitus (79%) or hypertension (63%).
In cases of sexual problems, most family physicians in our sample would have changed medication if relevant (79%) or would have referred patients to urologists (74%). According to the experience of approximately half of the physicians (9/19), sildenafil motivated more patients with sexual concerns to consult their physicians.
The physicians were asked for possible reasons for not talking about sexuality Table 2. Regarding physician-related factors, most physicians (53%) considered the lack of time a barrier to addressing sexual topics. Nearly all physicians (17/19) presumed that a feeling of shame keeps patients from talking about sexuality.
Importance of Sexual Medicine
On average, physicians rated the importance of sexual knowledge in family practice at a value of 7.2 on a 10-point Likert scale where 1 = not important at all and 10 = highly important. They rated the quality of their own knowledge 6.05.
There was a (nonsignificant) correlation between the physicians’ assumed knowledge and the patients’ wish to contact them in the case of sexual problems (rho=0.26; P=.29). Correspondingly, men were more likely to contact their physician for sexual problems if the physician assessed counseling in sexual medicine to be more important (rho=0.18; P=.47). The practice was the unit of analysis for calculating these correlations and their P values.
Discussion
Our study shows that sexual problems are widespread among male family practice patients and confirms the public health importance of this area. The high rate of men reporting sexual problems (93%) includes all patients who have or have had a sexual problem, independently of how often they suffered from it. Even if we consider the missing data (n=37) as representing patients without any sexual problem, the rate is still more than 80% and exceeds the incidence found by other authors.3,4,14,18 Our results confirm the survey of Metz and Seifert,2 in which nearly every patient had a sexual problem (97%) at some time during his life. Interestingly, this situation does not seem to be significantly different from the experience of women patients, according to a recently published survey of sexual problems among women seeking routine gynecologic care from the departments of family practice and obstetrics and gynecology.19 Nearly all the 964 women (99%) reported 1 sexual concern or more.
Health surveys reflect self-reported problems, not medically defined diseases. However, because sexual problems affect well-being and interact with other somatic and psychological complaints, family physicians should be aware that nearly all patients experience and report sexual concerns. Also, it should be recognized that 20% of patients suffer often or always from at least 1 sexual problem. These patients were significantly less satisfied with their sexual life than the remainder.
Similar to the results of other studies,1,9,20,21 we found that erectile dysfunction and low sexual desire increase with age. However, this was only a moderate correlation and should alert physicians to be cautious about regarding erectile dysfunction as an elderly man’s complaint. According to the patients’ own assessments, many sexual problems are related to occupational stress. Therefore, the family physician, with his or her knowledge of the patient’s family and social situation, is well prepared to identify men with sexual problems. For some men of our sample, these problems may be associated with sleeplessness or depression. In these cases, the family physician should address the interaction of diseases or drugs with sexual disorders.
The participating physicians were hesitant about initiating a discussion about sexual problems. This corresponds with the results of the patient survey, as only 12% of the men had already consulted their physicians in cases of sexual concerns. Half of the physicians stated that they have had more consultations about sexual concerns since the discussion about sildenafil started. This is in line with the hypothesis of Tiefer13 that the availability of sildenafil could motivate an increasing number of patients suffering from sexual problems to consult their family physicians.