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Rague JT, Hirsch J, Rosoklija I, Meyer T, Streur C, Kielb S, Cheng EY, Bowen DK, Yerkes EB, Chu DI. Male perspectives on clinical communication about sexual health in spina bifida. Dev Med Child Neurol 2024; 66:389-397. [PMID: 37421342 PMCID: PMC10772204 DOI: 10.1111/dmcn.15709] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/17/2023] [Accepted: 06/20/2023] [Indexed: 07/10/2023]
Abstract
AIM To assess perspectives on clinical communication about sexual health in young adult males with spina bifida. METHOD Semi-structured interviews were conducted between February and May 2021 with males at least 18 years of age with spina bifida to assess their perspectives and experiences of sexual health communication with clinicians. Demographic and clinical characteristics were obtained from chart review and a survey of patients. Interviews were transcribed verbatim, and conventional content analysis was used for transcript coding. RESULTS Twenty individuals participated with a median age of 22 years 6 months (range 18-29 years). Sixteen had myelomeningocele. Most identified as heterosexual (n = 17) and not sexually active (n = 13). Barriers and facilitators of successful interactions were identified. Barriers for participants included general discomfort with talking about sex and variability in individual preferences for how conversations occur. Facilitators included participants' comfort with their urologist and discussing sex in relation to disability. Suggestions for improving discussions included (1) notifying individuals that discussion about sex will occur before clinic visits; (2) creating space for discussions; (3) respecting individuals' readiness to discuss; and (4) making discussions disability specific. INTERPRETATION Young adult males with spina bifida are interested in discussing sexual health with their clinicians. Great variability exists about conversation preferences, emphasizing the need to individualize clinical communication about sex. Current health guidelines for males may not be in line with individuals' wishes. WHAT THIS PAPER ADDS Great variability exists in individual preference around sexual health communication. Patient-level barriers hinder successful conversations about sex. Individuals have great insight into how conversations about sex can be improved.
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Affiliation(s)
- James T Rague
- Division of Urology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Josephine Hirsch
- Division of Urology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Theresa Meyer
- Division of Urology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Courtney Streur
- Division of Urology, CS Mott Children’s Hospital, University of Michigan, Ann Arbor, MI, USA
| | - Stephanie Kielb
- Department of Urology, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Earl Y Cheng
- Division of Urology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Diana K Bowen
- Division of Urology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
| | - David I Chu
- Division of Urology, Ann & Robert H Lurie Children’s Hospital of Chicago, Chicago, IL, USA
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Sitto HM, Brodsky CN, Wittmann D, Wallner LP, Streur C, DeJonckheere M, Stoffel JS, Cameron AP, Sarma A, Clemens JQ, Ippolito GM. Patient and physician decision-making dynamics in overactive bladder care: A mixed methods study. Neurourol Urodyn 2024; 43:565-573. [PMID: 38334205 PMCID: PMC11054369 DOI: 10.1002/nau.25416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 01/18/2024] [Indexed: 02/10/2024]
Abstract
AIMS Overactive bladder management includes multiple therapeutic options with comparable efficacy but a range of administration modalities and side effects, creating an ideal setting for shared decision-making. This study investigates patient and physician health beliefs surrounding decision-making and expectations for overactive bladder with the aim of better understanding and ultimately improving decision-making in overactive bladder care. METHODS Patient and physician participants completed a questionnaire followed by a semi-structured interview to assess health beliefs surrounding decision making and expectations for overactive bladder treatment. The semi-structured interview guide, developed in an iterative fashion by the authors, probed qualities of overactive bladder therapies patients and physicians valued, their process of treatment selection, and their experiences with therapies. RESULTS Patients (n = 20) frequently cited treatment invasiveness, efficacy, and safety as the most important qualities that influenced their decision when selecting overactive bladder therapy. Physicians (n = 12) frequently cited safety/contraindications, convenience, cost/insurance, and patient preference as the most important qualities. In our integration analysis, we identified four key themes associated with decision making in overactive bladder care: frustration with inaccessibility of overactive bladder treatments, discordant perception of patient education, diverging acceptability of expected outcomes, and lack of insight into other parties' decisional priorities and control preferences. CONCLUSIONS While both patients and physicians desire to engage in a shared decision-making process when selecting therapies for overactive bladder, this process is challenged by significant divergence between patient and physician viewpoint across key domains.
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Affiliation(s)
| | | | | | | | - Courtney Streur
- University of Michigan, Department of Urology, Ann Arbor, MI
| | | | - John S. Stoffel
- University of Michigan, Department of Urology, Ann Arbor, MI
| | - Anne P. Cameron
- University of Michigan, Department of Urology, Ann Arbor, MI
| | - Aruna Sarma
- University of Michigan, Department of Urology, Ann Arbor, MI
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Rague JT, Hirsch J, Meyer T, Streur C, Rosoklija I, Kielb S, Cheng EY, Bowen DK, Yerkes EB, Chu DI. Reply by Authors. J Urol 2023; 210:546-547. [PMID: 37345478 DOI: 10.1097/ju.0000000000003556.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/11/2023] [Indexed: 06/23/2023]
Affiliation(s)
- James T Rague
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Josephine Hirsch
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Courtney Streur
- Division of Urology, CS Mott Children's Hospital, University of Michigan, Ann Arbor, Michigan
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Stephanie Kielb
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Earl Y Cheng
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Diana K Bowen
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Elizabeth B Yerkes
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - David I Chu
- Division of Urology, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Rague JT, Hirsch J, Meyer T, Streur C, Rosoklija I, Kielb S, Cheng EY, Bowen DK, Yerkes EB, Chu DI. "I Just Haven't Done Any of That": Applicability of the International Index of Erectile Function in Young Men With Spina Bifida. J Urol 2023; 210:538-547. [PMID: 37229716 PMCID: PMC10520848 DOI: 10.1097/ju.0000000000003556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Abstract
PURPOSE We evaluate the applicability of the International Index of Erectile Function in young men with spina bifida and identify spina bifida-specific sexual experiences not captured by this measure. MATERIALS AND METHODS Semistructured interviews were conducted between February 2021 and May 2021 with men ≥18 years of age with spina bifida. The International Index of Erectile Function was completed by participants, and perspectives on its applicability were discussed. Participant experiences and perspectives around sexual health were discussed to identify aspects of the sexual experience not well captured by the International Index of Erectile Function. Demographic and clinical characteristics were obtained from a patient survey and chart review. Conventional content analysis framework was used for transcript coding. RESULTS Of 30 eligible patients approached, 20 participated. Median age was 22.5 years (range 18-29), and 80% had myelomeningocele. Most identified as heterosexual (17/20, 85%), were not in a relationship (14/20, 70%), and were not currently sexually active (13/20, 65%). Some perceived the International Index of Erectile Function as applicable, while others reported it was not, as they do not define themselves as sexually active. Aspects of the sexual experience not captured by the International Index of Erectile Function included (1) lack of control over sexual function, (2) poor lower body sensation, (3) urinary incontinence, (4) spina bifida-specific physical limitations, and (5) psychosocial barriers. Participant suggestions for improving the International Index of Erectile Function to increase its applicability were identified. CONCLUSIONS While many perceived the International Index of Erectile Function as applicable, the measure inadequately captures the diverse sexual experiences of young men with spina bifida. Disease-specific instruments to evaluate sexual health are needed in this population.
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Affiliation(s)
- James T. Rague
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Josephine Hirsch
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Theresa Meyer
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Courtney Streur
- Division of Urology, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, MI
| | - Ilina Rosoklija
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Stephanie Kielb
- Department of Urology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Earl Y. Cheng
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Diana K. Bowen
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - Elizabeth B. Yerkes
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
| | - David I. Chu
- Division of Urology, Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, IL
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Streur C, Schafer C, Wittmann D. 196 Optimizing Sexual Satisfaction for Women With Spina Bifida: A Qualitative Study. J Sex Med 2020. [DOI: 10.1016/j.jsxm.2019.11.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Wittmann D, Streur C, Schafer C. 141 “If Everyone Else is Having This Talk with Their Doctor, Why am I Not Having This Talk with Mine?”: Th Experiences of Sexuality and Sexual Health Education of Young Women with Spina Bifida. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Wittmann D, Streur C, Schafer C. 064 “We can set you up for an abortion”: The Importance of Reproductive Health to Young Women with Spina Bifida and the Lack of Support from their Doctors. J Sex Med 2019. [DOI: 10.1016/j.jsxm.2019.01.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Lee* T, Corona L, Marchetti K, David B, Ivancic V, Kraft K, Park J, Sack B, Streur C, Wan J. MP64-02 INCREASED RISK OF REPEAT INFECTIONS PRIOR TO VESICO-URETERAL REFLUX DIAGNOSIS SINCE THE 2011 AAP GUIDELINES. J Urol 2019. [DOI: 10.1097/01.ju.0000556894.12764.e5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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