Common Pathology Review
Before we get started, let’s start by reviewing a selection of literature on ED and PE and sexual dysfunction and then check your knowledge.
STEP ONE: PREPARE
Sexual problems in men are more common than you may think. Andrology Australia quotes that about 1 in 5 Australian men over the age of 40 have problems with erectile dysfunction. About 1 in 200 men have androgen deficiency, and not all are diagnosed and when it comes to premature ejaculation; its frequency can be about 25% of men!
Yet, the reality is how many face to face consultations do you actually see of men with these problems?
Whilst common pathology, even the most experienced GP would agree that generally men avoid presenting face to face with these issues - except over the phone.
Interestingly, men’s sexual dysfunction presents significantly disproportionately in telehealth - so get ready for men, for obvious reasons, be more comfortable over the phone discussing this with you rather than their local Doctor they've known for years!
BTW This doesn’t necessarily mean they don’t want their regular Doctor involved however, so how we integrate our care with their local Doctor becomes an important ongoing issue too when it comes to chronic disease care.
You will find that overall, men do care about their health. In fact, most men over 40 will have visited a doctor in the past 12 months. However, when compared to women, we know that men visit the doctor less often, have shorter consultations, and tend to see their GP later.
Tailoring our consultation to suit men's needs is important. Our aim is to improve male health outcomes in sexual health but also to maximizing this opportunity to effectively engage men in their overall health care too explaining our focus on preventative cardiometabolic care as well as mental health.
There are handy scripts and tips in How to perform Stage 1 and Stage 2 which gives examples of how to engage men in general discussions about their health to get you started.
As you practice this skill over the next 6 months, you'll be practicing the art to approaching sensitive topics around sexual health.
To get you started: This article is useful for the psychosexual consultation.
You'll be practicing motivational interviewing techniques too particulary in stage 2 consultations after interpreting test results as a springboard for lifestyle modifications.
To get started: This article is useful for the motivational interviewing too.
As you will discover, sexual dysfunction becomes the perfect window or opportunity for men’s general health care and in particular lifestyle management. In men’s sexual dysfunction, men can get very motivated! Use the opportunity.
As you will discover, sexual dysfunction becomes the perfect window or opportunity for men’s general health care and in particular lifestyle management.
In men’s sexual dysfunction, men can get very motivated! Use the opportunity.
One of the most important jobs for our front line practitioners is to explain that male sexual dysfunction problems such as Erectile Dysfunction (ED) are often symptoms of underlying diseases and can offer tell you a lot about their health.
The “survival of the firmest” saying affirms that
“a man is only as old as his arteries”.
This has never more true than when assessing male sexual dysfunction. For example, many studies have shown that Erectile Dysfunction (ED) is a powerful predictor of future coronary artery disease.
When explaining this in simple terms for men, personally, I use the analogy of Erectile Dysfunction to be like this canary in the mine.
The erection that can’t happen or be sustained can give important clues about poor lifestyle and arterial disease 3-4 years before chest pain even strikes.
If a canary acted strange or died, then miners recognized they needed to exit the mine because they could also be at risk of death. Using this analogy of erectile dysfunction being like the canary in the coal mine can help man understand the importance of seeing this as a symptom of a big picture issue.
It is important to start getting men into the mindset that men’s sexual dysfunction is about much more than prescribing a little blue pill (which many have already tried anyway!)
Instead, it’s about looking for a reversible cause, treating with a total team care approach and preventing it from getting worse!
It's a brilliant opportunity to offer men a snapshot of their general health and provide opportunities to prevent future illness too.
It is likely in a Stage 1 IMA you will typically need to differentiate the following common men’s sexual dysfunction issues of:
So to get started, let's revise from a selection of professional reviews on the topic from an Australian literature review of erectile dysfunction, premature ejaculation and androgen deficiency which covers the common pathology.
STEP TWO: LEARN
Read the following articles before answering MCQ questions
Ian Smith et al. Erectile Dysfunction. When tablets don’t work. AFP 39 (5) May 2010Eric Chun et al. Premature Ejaculation: A clinical review for the general physician. AFP 44 (10) October 2016Irene Chan. et. al. Assessment and management of male androgen disorders: an update. AFP 43 (5) May 2014.Vijayasarathi Ramanathan, Margaret Redelman. Sexual dysfunctions and sex therapy The role of a general practitioner AJGP VOL. 49, NO. 7, JULY 2020
Stat Pearls: Erectile Dysfunction