Although physicians have made good progress in facilitating medical discussions around sexual health over recent years, many male patients are still reluctant to bring up concerns directly with their doctors. Out of the 30 million men in the US who experience ED, only 5%–10% seek medical help or request treatment.1
Overall, clinicians need to understand a patient’s hesitation as a sign that more proactive, thoughtful, and tactical approaches are required to drive meaningful conversations. The ability of physicians to communicate with patients is directly tied to the ability to successfully treat ED and the emotional or physical risk factors associated with it.
Primary care physicians are often the first to identify ED in patients. However, it is not uncommon for physicians and staff to have a lack of familiarity or training on ED in general. Medical staff and physicians may avoid discussing essential topics related to sexual functions due to a lack of knowledge, experience, or comfort with the subject.
In this case, clinicians need to remember that simply establishing and identifying ED in a patient is significant enough to start the process of care and treatment. Furthermore, establishing a process for screening and discussing ED with patients will mitigate any discomfort or unfamiliarity from the clinician’s side.
Establishing a Screening Process
Some physicians find it easiest to approach the conversation about sexual health, and ED in particular, when reviewing the patient’s history, health, existing medical conditions, or during a discussion of the patient’s social history. Including at least one or more screening questions about sexual activity in a written history form filled out by the patient is a good start to allowing patients to passively identify concerns they may have.
Nurses and other healthcare support staff are often the first to uncover a patient’s concern while fielding initial screening questions or reviewing forms. Therefore, physicians should educate nurses and administrative support staff on the signs, symptoms, and topic sensitivity surrounding ED to best align with any established communication process.
Ideally, a routine system of always asking sexual wellness questions with any sexually active patients can ensure that sexual health and function discussions become a regular and expected subject matter during office visits.
Asking Direct Questions
There are many ways to introduce the topic of sexual activity in direct patient conversations.
Often, having a flexible approach that considers the patient’s age, views, or cultural background is best. Before you or support staff approach a discussion about erectile dysfunction with any patient, it is essential to remove your own bias or discomfort with the topic. Remember that how you or staff approach the issue sets the tone for the patient. Being comfortable with the subject before talking to someone about it will go a long way to ease patient discomfort.
Tips to keep in mind when setting the tone for an open and confident dialog:
- Take the lead with the conversation and use a non-judgmental and inclusive tone.
- Remind patients that your conversations are always confidential.
- Questions on sexuality should be neutral and sensitive to culture, religion, or sexual preference and lifestyle.
- Provide explanations and allow patients to respond with questions.
- Use language and medical terminology that is clear and direct.
If a chronic illness associated with ED, such as obesity, hypertension, or heart disease, is already identified, physicians should go the extra step to weave ED questions into the health assessment.
Questions to help establish an ED connection might include asking:
- How has your chronic illness affected your sex life?
- Do you or your partner have any sexual concerns?
- Has having diabetes or hypertension affected your romantic relationship in any way?
Another approach is to offer a statement instead of asking direct questions, such as patients with this similar physical or psychological concerns report some difficulty having an erection. Do you have a similar experience?
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