Using the Sexual Review of Systems for Proper Diagnosisby PEhomepage.com Editorial Team
Primary care physicians fail to diagnose sexual disorders like premature ejaculation even though there are large numbers of men affected. Premature ejaculation is often self-reported, making the patient-physician relationship critical to the diagnosis and treatment process. Physicians often report that they are not trained to treat sexual disorders, while patients are uncomfortable discussing sexual dysfunctions with physicians.
One study found that 71% of men felt that their physician would not take them seriously if they reported a sexual issue. In addition, this same study reported that 68% of men thought their doctor would be embarrassed to discuss sexual issues. These attitudes affect the patient’s assessment of the adequacy of treatment – 76% felt that physicians would be unable to treat their problems with any type of effectiveness.
In order for doctors to adequately treat patients, the authors suggest a sexual review of systems. The first step should be a detailed medical and sexual history of the patient. In fact, the authors note, “The sexual history is the cornerstone of diagnostic assessment for all sexual dysfunctions, including PE (premature ejaculation).”
The initial interview should be conducted in the context of a relaxed patient conversation where solid rapport has been established. Cultural sensitivity is also required in order to make men feel as comfortable as possible. The authors recommend the patient-centered approach to the interview process.
During the interview, the physician needs to determine why premature ejaculation is an issue for the patient at the time that it is reported. There are several standardized questionnaires available to physicians that can assist with the assessment process. Such scales can be paper or Internet based and may be useful tools in initiating conversation with the patient. Some of the tools available include: the International Index of Erectile Function (IIEF), the Sexual Health Inventory for Men (SHIM), and the Male Sexual Dysfunction Scale.
This type of patient assessment can also be known as a sexual review of systems. Physicians need to become familiar with cultural issues affecting sexuality and a man’s willingness to discuss sexual issues. For example, Middle-Eastern men are less likely to discuss sexual issues in the presence of their female partner. Religious upbringing may affect the type of terminology that a man uses to describe sexual functioning. Finally, the physician should gain the patient’s permission to discuss sexual functioning during the interview.
The American Urological Association issued recent guidelines to assist physicians in the clinical assessment of premature ejaculation since there are varying definitions of the disorder. First, patients reporting issues with premature ejaculation should be given a complete sexual history assessment. Second, if patients present with erectile dysfunction and premature ejaculation, the erectile dysfunction should be treated first. Some men are unaware that the loss of an erection after ejaculation is normal, thus reporting an erectile dysfunction when the underlying cause is premature ejaculation. Finally, an interview with patient’s sexual partner can provide significant information as to overall sexual functioning and expectations.
This thorough systems review will assist in screening out co-existing issues that can affect premature ejaculation. Some of these areas include early ejaculation caused by alcohol or substance abuse. In addition, determining the length of time that the person has been affected by premature ejaculation will be useful in the treatment process. A sudden onset can indicate an underlying medical concern, whereas a lifelong issue may need a different type of treatment. Without a thorough assessment, physicians are likely to overlook issues that may contribute to premature ejaculation and may hinder the patient’s recovery rate.
Source: Rosen, Raymond; Kountz, David; and Kuritzky, Louis. “Managing Sexual Problems in Primary Care: Focus on Premature Ejaculation”
University of
Medicine & Dentistry of
New Jersey – Center for Continuing and Outreach Education, September 2005.
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