Les problemes d'erection: une souffrance encore trop souvent cachee

Doctors Talking About Sexuality: What Are the Patients' Feelings?

INTRODUCTION

Many medical practitioners avoid discussing the subject of sexuality with their patients because they are afraid of invading their privacy.

AIM

This study was carried out to discover what patients feel when asked about their sexuality by their GP.

METHODS

A qualitative study was carried out that involved 96 patients aged 18 to 86. The patients were recruited from 4 medical offices in the South of France. A substitute general practitioner asked the patients, "How is your sexuality these days?" during routine consultations. The patients were then asked how they felt about that question in semi-structured interviews.

MAIN OUTCOME MEASURES

This study highlights the existence of a discrepancy between physicians' beliefs and patients' expectations. Indeed, physicians fear that they would embarrass their patients if they address the subject of sexual intimacy. As it turns out, 93% of the patients would have welcomed that question.

RESULTS

34 patients (35%) were surprised by the question. 7 patients (7%) found the question unwelcome. 89 patients (93%) had a neutral or positive feeling. 78 patients (81%) deemed that sexual history should form an integral part of GP consultations (50% were in favor of systematic screenings for sexual dysfunctions, while 31% preferred targeted screenings). 2 patients (2%) found that the question had boosted their confidence and strengthened the doctor-patient relationship.

CONCLUSION

Most patients do not deem that their GP is invading their privacy if the GP touches upon the subject of sexuality, even if the patient's visit was for a different reason. Before addressing the issue, the GP must ensure that an appropriate framework of trust, care, and empathy is in place. If this framework is present, the patient will be able to overcome his/her feelings of surprise and know that there is a safe space to talk freely about this topic. Zéler A, Troadec C. Doctors Talking About Sexuality: What Are the Patients' Feelings?. Sex Med 2020;8:599-607.

La dysfonction érectile chez les patients hémodialysés au CNHU-HKM de Cotonou: profil épidémiologique

But

Étudier le profil épidémiologique de la dysfonction érectile (DE) chez les hémodialysés du CNHU.

Matériels et méthodes

Il s’agissait d’une étude transversale descriptive réalisée par l’équipe du service d’urologie dans le service d’hémodialyse du CNHU de Cotonou portant sur 58 patients hémodialysés. La forme abrégée de l’Index international de la fonction érectile (IIEF-5) a été utilisée pour l’appréciation de la fonction érectile. Un questionnaire préétabli a permis de recueillir les données sur le profil épidémiologique des patients.

Résultats

Les patients étaient âgés de 27 à 78 ans avec une moyenne d’âge de 56,3 ans. 96,6 % de nos patients étaient mariés dont 10,3 % de polygames. Les principales étiologies de l’insuffisance rénale chronique (IRC) étaient l’hypertension artérielle (HTA) mal suivie (87,9 %) et le diabète (12,1 %). La prévalence de la DE était de 75,9 % dont 29,3 % de DE sévères. Certains facteurs étiologiques ont été retrouvés en ce qui concerne la DE: il s’agissait de l’alcool (36,2 %) et du tabac (12,1 %). La DE était présente chez 9,1 % des patients avant la découverte de l’insuffisance rénale, et 72,7 % des patients avaient affirmé avoir constaté l’insuffisance érectile avec le début des séances de dialyse. Pour 39 patients (88,6 %), la DE se serait accentuée au cours des séances de dialyses. Les troubles sexuels associés étaient une baisse de la libido chez 25 % des patients (11/44) et une éjaculation précoce chez 34,1 % (15/44). Une hypotension artérielle a été notée chez 25 % des patients (11/44). Une hyperglycémie a été retrouvée chez 22,7 % des patients (10/44).

Conclusion

La DE, complication fréquente survenant sur les terrains d’IRC, a un impact négatif sur la qualité de la sexualité de nos patients hémodialysés. Une prise en charge de ce trouble devrait permettre d’améliorer la qualité de vie de ces derniers.

[Why and how to explore erectile function in patient with cardiovascular risk?]

Erectile dysfunction (ED) is a frequent disorder, which can be the first symptom of an underlying pathology such as cardiovascular diseases. Doctors should have a good understanding of erectile dysfunction and must be aware of the importance of detecting and investigating any erectile disorders. Detection of an erectile dysfunction induces to search underlying cardiovascular diseases, but also urinary symptoms, hormonal deprivation, mood and relational alterations and iatrogenous complications. Determination of erectile disorders therefore represents an excellent opportunity to conduct a work-up of this symptom, as an integral part of health policy.

[Erectile dysfunction, a new symptom for the cardiologist]

During many years, the symptom of erectile dysfunction was a matter for the urologist or the sexologist without efficacious treatment. Since 1999, the unexpected efficacy of sildenafil initially tested as a coronary vasodilatator emphasized the major role of an endothelial dysfunction potentially corrected by type 5 phosphodiesterase inhibitors (5-PDEI), which are able to reinforce the NO-dependant vasodilatation of cavernous arteries. Due to the medicalisation and the mediatisation of erectile dysfunction during the past five years, this symptom is now a matter for the cardiologist. The first reason was the query of cardiovascular safety of 5-PDEI. American and Britannic registries have established a good cardiovascular tolerability of these drugs including in patients with coronary heart disease according to the respect of contraindication in cases of coprescription with nitrates. The second was the association of erectile dysfunction with many cardiovascular risk factors concerned by the cardiologist. The third reason was the observation that erectile dysfunction could be a potential marker to identify patients with silent myocardial ischemia and relevant coronary artery disease. The Princeton consensus provides guidelines to help the cardiologist in the evaluation of patients with erectile dysfunction according to the cardiovascular risk level. Henceforth, erectile dysfunction should be considered by the cardiologist as "a sound of silence" of myocardial ischemia and should encourage to more aggressive evaluation and treatment of cardiovascular risk factors.