Lets Talk About Sex: Identifying Erectile Dysfunction in Primary Care

By: Indira Maurer, DNP, MSN, FNP-C

Erectile Dysfunction (ED) is a condition that affects approximately 30 million men in the United States¹. While it is not a condition secondary to aging, it is more common in older men with diabetes and / or hypertension¹. Some of the potential risk factors include¹:

1. Diabetes
2. Hypertension
3. Medications for hypertension, depression, & allergies
4. Treatment for prostate cancer or benign prostatic hypertrophy
5. Surgery of the pelvic area or spinal cord
6. Tobacco products or alcohol consumption
7. Sleep disorders

While more than 95% of ED cases can be treated successfully, many ED cases go unreported¹. Patients may refrain from sharing their symptoms due to embarrassment, shame, resigned that it is secondary to aging, or lack of knowledge that treatment options exist². This makes identifying the issue that much more challenging for providers. As providers, we can remove the barriers patients face when discussing ED. Talking about ED can be challenging for providers and patients alike, yet there are steps we can take to help remain professional, relaxed, and supportive while allowing our patients to feel comfortable⁴.

• Establish a good rapport with your patient⁴.
• Take the initiative and don’t hesitate to introduce the topic of ED³.
• Ensure the patient’s privacy and confidentiality is preserved³.
• Listen carefully to the patient with an optimistic attitude⁴.
• Try to be at ease with the vocabulary used4. Keep the sexual terminology simple and direct³.
• Discuss symptoms and treatment options without judgment or shaming⁴.
• Maintain sensitivity to any existing cultural and / or religious beliefs⁴.
• Allow the patient to ask questions and obtain clarification as needed³.
• Utilize passive approaches for introducing the topic of ED:
  • Offer brochures or pamphlets on sex-related topics³.
  • Utilize screening or self-evaluation material such as the Sexual Health Inventory for Men³.
  • Display educational posters in patient exam rooms or waiting areas³.
  • Include questions about sexual health when a printed history form is completed by the patient³.
• Utilize active approaches for introducing the topic of ED:
  • Initiating conversations about sexual activity during the health history or the physical examination³.
  • Questions may explore specific symptoms such as inability to achieve an erection, inability to maintain an erection, onset, and frequency of these symptoms, etc³.

With almost half the male population being affected by some form of ED, the taboo and shame behind their sexual dysfunction hinders the open communication between patients and providers. While providers do not have to be experts on the various treatment approaches for ED, the power to engage our patients in this conversation is in our hands. By extending the safe space to allow patients to talk about their symptoms and sexual concerns, we in turn achieve the ability to determine the best steps towards successfully regaining their sexual health.

References

1. Diabetes and men. Centers for Disease Control and Prevention. March 15, 2022. https://www.cdc.gov/diabetes/library/features/diabetes-and-men.html#:~:text= Erectile%20Dysfunction%20(ED),more%20likely%20to%20have%20E
2. Al-Shaiji, Tariq F. “Breaking the Ice of Erectile Dysfunction Taboo: A Focus on Clinician–Patient Communication.”Journal of Patient Experience 9 (2022): 23743735221077512.
3. Sadovsky, Richard. “Asking the questions and offering solutions: the ongoing dialogue between the primary care physician and the patient with erectile dysfunction.”Reviews in Urology Suppl 7 (2003): S35.
4. How to talk with patients about erectile dysfunction (ED). Accessed May 19, 2023. https://www.bostonscientific.com/content/dam/American-Medical-Systems/diabetic Educators/tips/MH-397502-AA_Tips%20for%20the%20ED%20Talk-ED_FINAL.pdf.