Original Research

Sexual Problems of Male Patients in Family Practice

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OBJECTIVE: Little is known about men’s expectations of their family physicians regarding sexual disorders. Our goal was to evaluate the frequency of sexual problems among male patients in family practice and to assess their need for help.

STUDY DESIGN: We performed a cross-sectional survey based on structured questionnaires answered by patients and physicians in German family practices.

POPULATION: We approached 43 family physicians; 20 (43%) participated. On a single day all men 18 years and older visiting the participating practices were approached, and 307 (84%) took part in the survey.

OUTCOME MEASURE: Patients were asked about their frequency and type of sexual problems, their need for help, and their expectations of their physicians. The physicians described their perceptions and management of sexual problems in family practice.

RESULTS: Nearly all patients (93%) reported at least 1 sexual problem from which they suffered seldom or more often. The most common problems were low sexual desire (73%) and premature ejaculation (66%). Occupational stress was considered causative by more than half of the men (107/201). Forty-eight percent considered it important to talk with their physicians about sexual concerns. However, most physicians initiated a discussion about sexual concerns only seldom or occasionally. There was a nonsignificant correlation between the physicians’ assumed knowledge and the patients’ wish to contact them in case of sexual problems (rho=0.26).

CONCLUSIONS: The high frequency of self-reported sexual disorders and the hesitancy of family physicians to deal with this topic signals a neglected area in primary health care. Certain conditions, such as occupational stress, which may be associated with sexual concerns, should encourage the physician to initiate discussions about sexuality.

Sexual dysfunction in men is common. A large study1 in the United States with a sample of 1410 men found a 31% 12-month prevalence of sexual dysfunction. In a small US survey2 of 62 men, nearly all participants reported sexual concerns at any time during their life. One third of 789 men in a British general practice reported a current sexual problem.3 Three fourths of 78 patients surveyed in another British general practice suffered from general sexual problems; 35% reported a specific sexual dysfunction, such as premature ejaculation or erectile dysfunction.4

Sexual dysfunction may have organic or psychological causes. The family practice setting seems to be ideal for the evaluation and management of sexual dysfunction, because family physicians usually know the personal and family situation of their patients.5-8Also, sexual dysfunction is sometimes related to common diseases, such as diabetes mellitus.9,10 Medications frequently prescribed in family practice, such as antihypertensive and psychiatric drugs, may also adversely affect sexual performance.11,12 Finally, the popularity of sildenafil (Viagra) and the accompanying publicity may encourage an increasing number of patients with erectile problems to consult their family physicians in case of sexual problems.13

It is important for the family physician to recognize the spectrum of sexual problems among men, since these concerns may affect their patients’ health, wellbeing, and relationships. There are only a few small studies on sexual dysfunction in family practice,2-4,14 with limited generalizability. Most of the authors did not correlate physicians’ and patients’ views on this topic. Little is known about what men expect from their family physicians in cases of sexual disorders. We performed a survey of male patients and their physicians, focusing on the frequency and types of sexual problems in family practice, the men’s expectations of their physicians in case of sexual problems, the physicians’ perception and management of sexual problems, and the influence of physicians’ knowledge of and attitude toward sexual medicine on patients’ help-seeking behavior.

Methods

Study Population

All board-certified family physicians in the 2 districts of Hildesheim (Lower Saxony) and Heiligenstadt (Thuringia, the former East Germany) in the North of Germany were asked to take part in the study and complete a self-administered questionnaire. For one day all male patients in the participating practices 18 years or older and capable of reading the German language were asked to complete a questionnaire in a separate room of the practice and, after finishing, to put it into a box. Neither the physician nor the practice nurses had access to the box.

Questionnaires

We developed a 3-page questionnaire for family physicians and a 4-page patient questionnaire. A multiple-choice format was chosen with some room for personal comments. The patient questionnaire was pilot tested on a sample of 20 men attending a family practice; these men did not take part in the final study. The patient questionnaire had 3 parts: the quality of the patient’s relationship with the family physician with regard to sexual problems; the frequency, presumed causes, and effects of sexual dysfunction; and the patient’s view of the physician’s management of sexual problems.

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