175 Reinventing the Selfie: Telemedicine in a Tertiary Referral Sexual Medicine Practice

Abstract

Urologists are increasingly using videoconferencing/electronic messaging to improve patient access. The value of telemedicine to patients is often proportionate to the logistical burden of seeking care, often underutilized by individuals requiring tertiary referral subspecialists. The sensitive nature of sexual dysfunction may deter urologists from offering telemedicine encounters to patients with erectile dysfunction, orgasmic disorders, pelvic pain. We performed a retrospective analysis of photo-augmented tele-consultation at a tertiary referral sexual medicine practice to characterize scope and feasibility. 428 tele-consultation encounters in a one-month period were reviewed to reveal more than 5000 encounters occurred per year. Submissions with graphic files (.jpg, .png, .tif, .pdf) were included in the study, as graphic data transmission is a distinct departure from capabilities of traditional phone consultation. 31(7.2%) of encounters included graphic files and were included in the study. 12 (39%) encounters were from male patients, 19 (61%) were from female patients. Two (6%) encounters were new patients, the remaining had previously established care. Patients were from 7 states within the USA, as well as two European countries (Germany, Italy). Diagnoses included: Peyronie's disease, erectile dysfunction, post-finasteride syndrome, neuroproliferative vestibulodynia, persistent genital arousal disorder. Reasons for tele-consultation were questions about: physical diagnosis (23%), prescribed devices, interventions, or medications (23%), or results (54%). 9 (29%) encounters included selfies of their external genitalia: penis, clitoris, perineum, perineum with posterior vulva, mons pubis and anterior vulva, vestibule. Patients included photos of intracavernosal injection devices as well as coolers and lock-boxes for medication storage. Remaining graphic files consisted of operative reports, spinal MRI, penile Doppler images, hormone profile reports.