GENERAL PRACTITIONERS’ PRACTICE PATTERNS: DIAGNOSING AND TREATING SEXUAL PROBLEMS

ObjectivesMany chronic diseases and their medications may induce sexual problems. This study aimed to evaluate whether general practitioners (GPs) raise sexual health issues during appointments with patients who have chronic diseases. Study designA web-based questionnaire was distributed to a random sample of 1,000 GPs in Finland. Main outcome measuresThe study aim was to determine GPs’ self-reported inquiry into sexual problems with patients who have chronic diseases and GPs’ awareness of medications inducing sexual problems. ResultsOnly 16.2% of the GPs inquired about sexual health issues, typically during appointments dealing with reproductive organs. A majority (66.9%) considered sexual problems to be side-effects of medications, but only 17.9% followed up about them. Compared to male GPs, female GPs were more likely to inquire about gynecologic patients’ sexual issues (OR 1.77, 95% CI 1.05–2.99), but less likely to ask about them with urologic (OR 0.56, 95% CI 0.35–0.91) and neurologic patients (OR 0.35, 95% CI 0.17–0.72). The GPs aged 40–49 and 50–65 were more likely than those aged 27–39 to inquire about sexual health issues among patients with cardiovascular (OR 2.87, 95% CI 1.11–7.44, OR 2.89, 95% CI 1.16–7.19) and neurologic (OR 4.63, 95% CI 1.45–14.82, OR 5.68, 95% CI 1.87–17.23) diseases. ConclusionsGPs seldom inquire about sexual problems with patients who have chronic diseases or after prescribing medications for these conditions, which may lead to underdiagnosis and undertreatment of sexual problems.

ObjectivesThe objectives of our study were (1) to investigate the association between gender of the general practitioner (GP) and the quality of primary care in Hungary with respect to process...

Introduction Sexuality and religion are intricately intertwined. Although religion is associated with sexual taboos, religious texts are among the first and most consistent sources to discuss sex, and more specifically, sexual dysfunction. Sexual dysfunction has always been widely prevalent, and a cause of individual, social, and spiritual distress. As sex and society continue evolving within frameworks of religious thought and practice, it is important to understand what religions have historically taught regarding sexual dysfunction and how it may impact their communities today. Objective To provide a broad overview and comparison of how clinical literature illustrates major world religions’ understanding and management of sexual dysfunction, both in their historical texts or traditions and in the modern day. This study aims to illustrate that sexual dysfunction has been addressed by religions since their inceptions. Due to their widespread and historical popularity, we explore Judaism, Christianity, Islam, Hinduism, and Buddhism. Methods We conducted a literature search through the OVID (Medline) database using the terms “sexual dysfunction,” “erectile dysfunction,” “religion,” “Islam,” “Christianity,” “Buddhism,” “Judaism,” and “Hinduism,” with a particular focus on articles that addressed foundational ancient texts, historical teachings, or what is being taught today. From these findings, we identified any articles that explored specific religions’ perceptions and teachings (modern day or ancient) regarding sexual dysfunction. Due to the expansive and idiosyncratic nature of religious belief and practice, we cannot fully represent the unique complexities and perspectives that any of these religions may offer with respect to this topic. Instead, we emphasize the common denominators generally shared within and between religions, as well as those which were available in the literature. Results The religions of Islam, Christianity, Buddhism, Judaism, and Hinduism all acknowledge sexuality as an integral part of human society and individual expression. These religions all address sexual dysfunction as a potential threat to the ideal participation of the affected person within their community. This is universally true, despite variances in the specific statutes and guidelines defining ideal sexual practice for each religion. In addition, despite frequently opining on the management of women’s bodies, particularly the bodies of women of reproductive age, we found a relative deficit of discussion regarding sexual dysfunction among women in religious literatures. Also, we identified a possible tendency to conservativism, with religious discourse acknowledging the changes in sexual medical and surgical practice over time, but often delaying (or less frequently, declining) their integration with religious mores. Finally, we highlight the cyclical nature of many religions' discussion, or lack thereof, regarding sexual dysfunction. Conclusions Ultimately, our findings identify a constant concern with sexuality and sexual dysfunction across major religions worldwide, which is characterized by a cyclical progression and regression in the incorporation of secular biomedical attitudes, diagnostic, and therapeutic options for sexual health. Awareness of these patterns and religion-specific beliefs about sexual dysfunction has potential to optimize patient-centered care and advocacy within and on behalf of different patient populations. Disclosure No

BackgroundSuggestions of overprescribing of proton pump inhibitors (PPIs) for long-term treatment in primary care have been raised. This study aims to analyse associations between general practice characteristics and initiating long-term treatment with PPIs.MethodsA nationwide register-based cohort study of patients over 18 years redeeming first-time prescription for PPI issued by a general practitioner in Denmark in 2011. Patients redeeming more than 60 defined daily doses (DDDs) of PPI within six months were defined first-time long-term users. Detailed information on diagnoses, concomitant drug use and sociodemography of the cohort was extracted. Practice characteristics such as age and gender of the general practitioner (GP), number of GPs, number of patients per GP, geographical location and training practice status were linked to each PPI user. Logistic regression analysis was used to determine associations between practice characteristics and initiating long-term prescribing of PPIs.ResultsWe identified 90 556 first-time users of PPI. A total of 30 963 (34.2 %) met criteria for long-term use at six months follow-up. GPs over 65 years had significantly higher odds of long-term prescribing (OR 1.32, CI 1.16-1.50), when compared to younger GPs (<45 years). Furthermore, female GPs were significantly less likely to prescribe long-term treatment with PPIs (OR 0.87, CI 0.81-0.93) compared to male GPs.ConclusionsPractice characteristics such as GP age and gender could explain some of the observed variation in prescribing patterns for PPIs. This variation may indicate a potential for enhancing rational prescribing of PPIs.

Several studies have shown that men with lower urinary tract symptoms are more likely to experience erectile dysfunction. All except 1 of these studies were cross-sectional, limiting inferences about whether lower urinary tract symptoms precipitate erectile dysfunction. The association between lower urinary tract symptoms and incident erectile dysfunction was examined prospectively in the Health Professionals Follow-Up Study. Lower urinary tract symptoms were assessed biennially by the American Urological Association symptom index, which captures symptoms of frequency, urgency and force of urinary stream. Severe lower urinary tract symptoms was defined as a symptom score of 20 points or greater and no lower urinary tract symptoms was defined as a score of 7 points or less in men not treated for lower urinary tract symptoms. In 2000 the men were asked to rate erectile function for several periods. Erectile dysfunction was defined as poor or very poor function, or erectile dysfunction medication use, while no erectile dysfunction was defined as very good or good function and no erectile dysfunction medication use. We estimated the RR using Poisson regression, adjusting for age and other potentially confounding factors. We observed 3,953 incident erectile dysfunction cases among 17,086 men. Men with severe lower urinary tract symptoms in 1994 or earlier had a statistically significant 40% higher risk of erectile dysfunction subsequently than men without lower urinary tract symptoms. The risk of erectile dysfunction increased with increasing lower urinary tract symptom severity (p trend <0.0001). The positive association between lower urinary tract symptoms and erectile dysfunction was stronger in younger than in older men (p interaction = 0.03). This study provides evidence that men with lower urinary tract symptoms are more likely to have erectile dysfunction subsequently.

The impact of sexuality and quality of life (QOL) is one of the main concerns of IBD. Despite the obvious relevance of this problem, knowledge of the extent of sexual dysfunction (SD) in IBD is limited. Aim of this study was to assess the prevalence of SD and erectile dysfunction (ED), QOL their predictors, and their age-related dynamic in IBD patients. In this cross-sectional study, 202 IBD patients [122 male, 80 female, 133 Crohn's disease (CD), 69 ulcerative colitis (UC)] fulfilled International Index of Erectile Function (IIEF) or Female Sexual Functioning Index (FSFI). QOL was assessed using IBDQ-32 through bowel, systemic, emotional and social domains. Prevalence of SD in men was 18%, ED 30.3% and SD in women 75%. Low QOL was present in 34.6% without gender difference (P=.253). In men, SD and ED were highest among 21-30years and raising after 51years of age. In women, SD was constantly highly prevalent, showing no decline over time. In multivariate analysis significant predictors of SD in men were CD phenotype, disease duration and emotional domain of IBDQ, of ED depression, emotional and bowel domain of IBDQ, and of SD in women emotional IBDQ domain. Quality of sex life is a serious concern among IBD patients and is age related. Components that play a role in sexual functioning in IBD require more clarification and further development of screening and treatment guidelines for SD to provide better care in the IBD population.

Information and communications technologies (ICTs) are being used more and more by general practitioners (GPs) in their day-to-day activities. While a number of studies have shown that ICT adoption and use can provide real benefits to medical practices, there have been few studies to determine whether the perception of those benefits is uniform across the sector. This study examines whether differences in the perception of benefits exist between male and female GPs. The results suggest that the groupings and priorities of benefits arising from ICT use differ substantially between male and female GPs. Results also show, amongst other things, that male GPs are focussed on business efficiency, while female GPs are focussed on communication and practice expansion.

Sexual dysfunction in male and female alcoholic addicts was evaluated in a comparative study of 60 married alcoholics and an age-matched control group from a general practitioner's clinic. 63% of the alcoholic men reported sexual dysfunction - mainly erectile and libido disorders - compared with 10% in the control group. The frequency of sexual dysfunction in alcoholic women did not differ from that in controls. Approximately 25% of the women who reported sexual dysfunction had reduced libido. The male alcoholics claim the aversive treatment, (Antabus), to be the causative factor, and considered their problem began as soon as they started treatment. There was no change in masturbation or coital frequency in the month before and after initiation of treatment. The study discusses present knowledge of relevant etiological factors in sexual function and dysfunction in alcoholics - implicating a multifacetted therapeutic approach.

Let’s talk about sex

Male sexual dysfunction after fracture of the pelvis is more common than previously supposed with rates as high as 30% reported when the complaint is specifically sought. With the increase in survival from major injuries, the long-term consequences of trauma are being seen with increasing frequency

Management of Antipsychotic-Related Sexual Dysfunction: Systematic Review

Sexuality has a key impact on quality of life and on reproductive health. Infertility often results in sexual dysfunction. Despite this close association, addressing sexuality is not a standard component of infertility counselling, especially since in most countries sexual medicine is not a core element of specialist training. Even today, many doctors and patients consider discussing sexuality to be more challenging than other aspects of reproductive medicine. The present review addresses the complex consequences of infertility on sexuality. Our goals were: (i) to identify the prevalence of sexual problems resulting from infertility, (ii) to evaluate characteristics of sexual difficulties and disorders resulting from infertility and (iii) to analyse factors involved in the complex association between sexual problems and infertility. A systematic search for publications containing keywords related to sexual disorders and infertility was performed via PubMed, Web of Science and Psyndex. A total of 170 manuscripts published between January 1966 and April 2021 were identified after verification of inclusion and exclusion criteria. The reference lists in these manuscripts were searched for further relevant literature. Studies were reviewed for quality-related methodological details. Couples diagnosed with infertility have an increased risk of sexual disorders. Loss of sexual desire and erectile dysfunction are among the most frequent sexual disorders resulting from infertility. Currently available literature reflects only fragmentarily the complexity of the diverse interactions. Sexuality plays out against the backdrop of interactions among personal, cultural, infertility-related and sexuality-related factors. Considering this complexity, it is crucial to evaluate individual profiles as well as partnership interactions to avoid a negative impact of infertility on a couple's sexual life. Identifying sexual disorders as relevant considerations in the context of infertility and exploring their impact during the entire course of diagnosis and treatment constitute an important contribution to comprehensively care for the couples concerned. Counselling should focus on preventing the onset and aggravation of sexual disorders. As sexuality represents a major component of quality of life and of partnership, such support may improve not only the current overall wellbeing but also the chances of a satisfactory long-term partnership and family life.

Introduction Understanding and addressing sexual dysfunction is of paramount importance to enhance the overall well-being and quality of life of individuals worldwide. While significant progress has been made in the field of sexual medicine, variability in practice patterns among healthcare professionals remains a potential barrier to optimal patient care. To bridge this knowledge gap and identify the prevailing trends in sexual dysfunction management, we conducted an international survey targeting urologists specializing in Andrology, Sexual Medicine, and related fields. Objective This international survey aimed to assess male and female sexual dysfunction management practices among sexual medicine physicians across to globe to identify variability in practice patterns. Methods A survey was distributed globally to urologists specializing in Andrology, Sexual Medicine, and related fields who are members of International Society for Sexual Medicine (ISSM) or affiliated regional societies (SMSNA, ESSM, MESSM, APSSM, SASSM, SLAMS, ISSWSH, SIU). Demographic information (age, gender, specialty, and practice setting) and treatment approaches for male and female sexual dysfunction were collected. Respondents also reported the percentage of their practice dedicated to sexual dysfunction and whether treatments were covered by health insurance. Results A total of 200/3000 practitioners participated, with 101 (50.7%) identifying as urologists. The majority were male (72.9%) and worked in private practice or community hospitals (32.7%) or a mixture of both (34.2%). Male sexual dysfunction was treated by 71.4% of respondents, with 25.7% dedicating 75–100% of their practice to it. Female sexual dysfunction was treated by 36.9% of respondents, with 64% dedicating 0–25% of their practice to it. Health insurance covered 25–49% of their care for 41.2% of respondents, predominantly provided by private companies (45.9%). The most common treatments for erectile dysfunction were oral medications (86.5%), injections (61.7%), and inflatable penile prostheses (45.1). For Peyronie's disease, oral therapies (59.1%) and penile traction therapy (34.4%) were most frequently offered, while surgical treatment for Peyronie's disease was offered by 58.2% of respondents, with penile prostheses being the primary choice (79.7%). Regarding female sexual dysfunction, 58.4% of respondents offered treatments for genitourinary syndrome of menopause/atrophic vaginitis, with vaginal estrogen being the most common choice (50%). For dyspareunia due to vaginismus/hypertonic pelvic floor dysfunction, 50.3% of respondents offered treatment, with pelvic floor exercise/physiotherapy being the most recommended (66%). Conclusions This study provides valuable insights for healthcare professionals, policymakers, and researchers regarding the current landscape of sexual dysfunction management. The results underscore the importance of continuous efforts to develop comprehensive and individualized approaches, ensuring that both male and female patients receive effective and accessible care for their sexual health concerns. By addressing issues related to insurance coverage and fostering interdisciplinary collaboration, the medical community can collectively work towards improving sexual well-being and quality of life for patients worldwide. Disclosure Any of the authors act as a consultant, employee or shareholder of an industry for: Advisory board and speaker for Coloplast; consultant for Cynosure; advisory board and speaker for Halozyme; intellectual property with Masimo; advisory board for Promescent; consultant for Sprout; advisory board for Xialla.

While self-efficacy has been widely used to explain and treat various biobehavioral responses, few investigations have examined this concept in the context of sexual response and dysfunction. In this study, the authors constructed a measure of sexual self-efficacy, investigated whether it differentiated men with and without sexual dysfunction, and determined the utility of this construct by exploring its relation to other variables known to be related to erectile dysfunction in a sample of 60 men with erectile dysfunction and 14 functional men visiting a urology clinic. The sexual self-efficacy index differentiated men with and without erectile dysfunction, and general linear modeling showed that the index did indeed relate to other variables known to affect sexual and emotional response during a partnered sexual experience. These findings suggest that, as a unifying construct that predicts cognitive, affective, motivational, and behavioral responses, sexual self-efficacy has the potential to play an important role in the assessment of effective treatments for sexual problems.

NETUPITANT, A NEW SELECTIVE NK 1 RECEPTOR ANTAGONIST, REVERSES ACETIC ACID-INDUCED BLADDER OVERACTIVITY IN ANESTHETIZED FEMALE GUINEA-PIGS