Talking with Patients about premature ejaculation ( PE ) and other sexual dysfunctions
Since the 1990s, pharmacists have been placed into a position not formerly known to their profession: counseling patients with sexual dysfunctions about the proper use of medications relating to their disorder. Even though most medications dispensed are for erectile dysfunction, premature ejaculation ( PE ) is the most prevalent male sexual disorder.
When counseling patients about medication usage, pharmacists need to take into account the reason for the prescribing physician to use a particular medication, as well as other factors about the patient’s overall health. Specific to premature ejaculation ( PE ), the pharmacists should educate the patient about
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Expectations of how long the medication needs to be taken (on-demand vs. daily dosing),
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Side effects of the medication, and
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When to visit the patient’s physician if the medication does not appear to be working.
In addition, there are topical ointments such as lidocaine-prilocaine ( EMLA ) that could potentially be prescribed for treatment. Since numbing the penis glans appears to have some measure of effect in treating premature ejaculation ( PE ), some patients would rather try it instead of waiting for an antidepressant medication to take effect 1-2 weeks later. The pharmacist needs to be certain that patients understand:
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Correct use and removal the ointment prior to sex
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Acceptable wait times (usually 10-30 minutes) prior to initiating sex in order for the medication to reach its maximum potential effectiveness
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Numbing in the partner can occur if precautions are not taken.
Antidepressants are the preferred medication of choice among physicians since sexual side effects are a commonly reported side effect. Researchers in previous studies have noted that sexual side effects tend to be under-reported in clinical trials of antidepressants. For example, one study found that during a self-report assessment, 14 percent of patients reported sexual side effects. When queried directly, the number of patients reporting sexual side effects rose to 58 percent.
There are a variety of antidepressant medications on the market today, some of them more likely to cause sexual side effects than others. Studies of fluoxetine, paroxetine, sertraline, citalopram, mirtzapine, venlafaxine, and fluvoxamine all demonstrate these medications causing a high rate of sexual dysfunction – up to 50 percent in most instances. Mirtzapine has a lower rate of sexual dysfunction with only 18 percent reporting this effect. Bupropion has not been studied extensively in clinical trials of sexual dysfunction since it does not have serotonin activity and has a low incidence of sexual side effects.
One of the most successful roles of the pharmacist lies in patient education. Many physicians do not have sufficient time to devote to educating patients and thus, depend on pharmacists to help fill this need. Patients, in turn, rely on pharmacists to give accurate, timely information about the medication they have been prescribed. Pharmacists can also assist in managing expectations about the medication and discussing potential side effects that could be exhibited. In keeping with this role, pharmacists need to be well-educated about the types of sexual dysfunctions for which physicians are prescribing medications and the correct use of those medications.
Source:
Stimmel, Glen L. and Gutierrez, Mary A. “Counseling Patients About Sexual Issues.”
Pharmacotherapy. 2006; 26 (11), p. 1608-1615.
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