Clinical correlate 8 Taking a sexual history Study Questions
Reference Texts A. Nusbaum M, Hamilton CD The proactive sexual health history http://www.aafp.org/afp/20021101/1705.htRHml
Family physicians must proactively address the sexual health of their patients. Effective sexual health care should address wellness considerations in addition to infections, contraception, and sexual dysfunction. However, physicians consistently underestimate the prevalence of sexual concerns in their patients. By allocating time to discuss sexual health during office visits, high-risk sexual behaviors that can cause sexually transmitted diseases, unintended pregnancies, and unhealthy sexual decisions may be reduced. Developing a routine way to elicit the patient's sexual history that avoids judgmental attitudes and asks the patient for permission to discuss sexual function will make it easier to gather the necessary information. Successful integration of sexual health care into family practice can decrease morbidity and mortality, and enhance well-being and longevity in the patient. (Am Fam Physician 2002;66:1705-12. Copyright© 2002 American Academy of Family Physicians.) B. Summary from: Men’s Sexual Health Richard Sadovsky, MD , Stanley Althof, PhD Men's sexual issues Clinics in Family Practice Volume 6 • Number 4 • December 2004 Copyright © 2004 W. B. Saunders Company From the Department of Family Practice, SUNY-Downstate Medical Center, Brooklyn, New York (RS); and the Department of Psychology, Case Western Reserve College of Medicine, Cleveland, Ohio and Center for Marital and Sexual Health of South Florida, West Palm Beach, Florida (SA) ------------------------------------------------------------------------ * Full text reprints:: Richard Sadovsky, MD Department of Family Practice SUNY-Downstate Medical Center, Box 67 450 Clarkson Avenue Brooklyn, NY 11203 According to the National Health and Social Life Study, male sexual dysfunction is estimated to affect almost a third of the male population ages 18-59, with ejaculatory dysfunction (21%), erectile dysfunction (5%) and low sexual desire (5%) being the most common. The latter two problems are significantly higher in older men. Barriers in talking to male patients about sexual health Men are less likely to seek health for sexual problems, in part because in general, they do not visit doctors unless it is for a specific issue, rather than for preventive health care. They also tend to be less likely to speak openly about vulnerable issues or have difficulty articulating them. However, there is evidence that men would be willing to discuss sexual issues with their doctors and consider them appropriate for discussion with a primary care physician. Physicians also tend to focus on heart disease and diabetes with their male patients, instead of on quality-of-life issues and health behaviors. All a physician would need to do is provide a non-judgmental, supportive atmosphere, ask about sexuality, and offer help in an optimistic manner. The more the topic is incorporated into routine discussion at an appropriate time, for example while taking the social, the more likely it is that it is normalized. The authors suggest the following questions as ways to open the discussion. Open-ended Questions “So, how are you doing with sex lately?” “Are you satisfied with your sexual activity?”
Permission-Giving Questions “Many of my male patients your age have noticed some change in their sexual function. How about you?” “Many men with diabetes note some problems getting an erection. Are you noticing anything different?”
Questions for the partner “How has sex been lately?” “How has [name] been functioning?”
Questions for men who have chronic illness “How has your illness affected your sex life?”
Several screening tools are available in cluding a sex health inventory for men (Rosen RC, Cappelleri JC, Smith MD, Lipsky J, Pena BM. Development and evaluation of an abridged, 5 item version of the International Index of Erectile Function (IIEF-5) as a diagnostic tool for erectile dysfunction. Int J Impot Res 1999;112:319—26) and an androgen-deficiency screening questionnaire (Morley JE, Charlton E, Patrick P, Kaiser FE, Cadeau P, McCready D, Perry 3rd HM. Validation of a screening questionnaire for androgen deficiency in aging males. Metabolism 2000;49:1239–42)
It is also important to know how to deal with the issue of a patient’s sexual orientation. The physician and physician’s office should emphasize acceptance. The question can be broached by asking “Do you have sex with women, men or both?” The clinician should be care to use language that remains open to the possibility that the patient is gay. Sexual concerns among gay males are similar to those of heterosexuals. In general, including the partner in discussions is preferable.
The authors cite the acronym ALLOW as a means of approaching the patient about sexual matters. A=Ask. Without asking, the patient may not reveal sexual concerns. L=Legitimize. The patient needs to know that his concerns are accepted and valid. L=Limitations. The physician needs to know to what extent he/she is comfortable in dealing with sexual issues as well as his/her level of expertise. O=Open discussion The physician and patient must decide whether a referral is necessary or what additional matters must be considered that might affect treatment. For example, the clinician should explore whether the problem is organic or psychogenic, lifelong or recent. W=Work together. A treatment plan is developed.
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