Sexual Activity In Patients Research Articles

Restoration of sexual activity in patients with chronic hydrocephalus after shunt placement

Chronic (normotensive or low pressure) hydrocephalus is characterized clinically by gait disturbance, cognitive and urinary impairment, known as Hakim's triad. Nothing has been reported about impairment in sexual function, which could involve both the patient and the patient's partner. Out of 97 patients undergoing shunt placement for chronic hydrocephalus, 28 male patients (28.8%) referenced sexual dysfunction before operation. In these cases, we performed a preoperative and postoperative survey of sexual activity. In the preoperative period, all 28 patients reported having no sexual activity or arousal, from 2 to 4 years before the operation. Following shunt placement, 22/28 (78.5%) of patients regained variable sexual desire within a period ranging from 3 to 8 weeks, affording normal sexual activity with their partner. Sexual dysfunction can be part of the very early clinical background in patients with Hakim's triad and neuroradiological imaging compatible with chronic hydrocephalus. Restoration of sexual ability and arousal should be considered among the postoperative goals in these cases, together with improvements in cognition, gait, and urinary continence.

Effect of Level of Spinal Cord Injury and Urinary Catheterization on Sexual Function and Activity in Male Patients with Upper Motor Neuron Injury

Purpose: We investigated the effect of the level of spinal cord injury and urinary catheterization on sexual function and activity in male patients with upper motor neuron (UMN) injury. Materials and Methods: We reviewed patient's chart, radiologic and urodynamic study. We interviewed patient's sexual activity according to educational status, economic and marriage state, occupation, duration of spinal cord injury and pattern of voiding. A total of 114 male patients with neurogenic bladder due to UMN injury were included in the study. Group 1 consisted of 33 patients who underwent a clean intermittent catheterization (CIC) regimen and group 2 consisted of 81 patients with a suprapubic catheter, condom catheter, or Foley catheter. A detailed sexual behavior was taken for all patients to complete a questionnaire including the 5-item version of the International Index of Erectile Function (IIEF-5). Results: Satisfaction with intercourse (p=0.037) and total score (p=0.032) on the IIEF-5 were significantly higher in group 1 than in group 2. The other items on the IIEF-5 did not differ significantly between the groups. When the subjects were stratified according to level of spinal cord injury, 8 patients (18.6%) with cervical cord injury had no sexual activity, whereas 24 patients (33.8%) with non-cervical-cord injury did (p=0.048). Patients with no sexual activity were 12.1% (4/33) of the patients in the CIC group and 34.6% (28/81) of the patients who underwent other regimens (p= 0.016). Conclusions: Our results demonstrate that level of spinal cord injury and urinary catheterization may influence the sexual activity of male patients with UMN injury. Our results suggest that the CIC regimen had a positive effect on the sexual activity of these patients. (Korean J Urol 2009;50: 1225-1230) 󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏󰠏

Sexual self-concept, anxiety, and self-efficacy predict sexual activity in heart failure and healthy elders

Little is known about sexual activity in patients with heart failure (HF), and existing evidence suggests that sexual activity is adversely affected. This study explored the relationships and predictors between sexual activity and psychosexual, demographic variables in healthy elders and patients with HF. Participants were 59 healthy elders and 85 patients with HF who completed instruments on depression and anxiety, sexual self-concept, sexual activity, and demographic/clinical variables. Those with increased sexual self-concept had 1.78 greater odds of being sexually active. The sexual self-concept subscales of sexual anxiety and sexual self-efficacy showed a statistically significant (P < .01) independent effect on sexual activity. A higher sexual self-concept from greater sexual self-efficacy and lower sexual anxiety, younger age, and being married were significant predictors of sexual activity. Sexual self-concept and the related subscales of sexual anxiety and sexual self-efficacy are important psychosexual variables for future research. Attention to patient psychosexual concerns is needed in both clinical practice and research.

A study of Irish cancer specialists’ opinions regarding sexual health for cancer patients

20673 Background: Quality of life is an important aspect of cancer care. Sexual health is a feature of quality of life. Cancer patients may experience neutropenia secondary to disease or treatment. Yet, there is an absence of data on the risks to cancer patients from sexual activity when neutropenic. The aim of this study is to determine present opinion and practice by cancer specialists in Ireland regarding the sexual health care of cancer patients. Method: A cross-sectional survey using a confidential, self-administered questionnaire was performed of all ‘113’ identified consultants (75) and specialists registrars (38) in medical and paediatric oncology, haematology and palliative care attached to major cancer centres in the Republic of Ireland. Two reminders were sent. Descriptive and content analysis were performed on the quantitative and qualitative data respectively. Results: 43 (response rate of 37.5%) replies were received. While the majority of respondents 23/14 discussed to varying degrees the possible impact of cancer and treatment on fertility with patients, if applicable, only 1 ’always’ discussed the possible impact of cancer on sexual activity. Opinions regarding the risk of sexual activity in patients included: infection risk to women with neutropenia, possible infection-risk benefit of condom-associated sexual activity, bleeding secondary to related thrombocytopenia. In some cases this questionnaire provided the first opportunity to consider such issues. Concern was raised about the adequacy of medical training regarding sexual health care of patients. Conclusions: Diversity in medical advice and opinions regarding possible risks to cancer patients and specifically with neutropenia from sexual activity are evident. The sensitive nature of sexual health counselling, in this cohort of patients, together with the paucity of evidence, proved limiting factors to therapeutic dialogue. Further research is necessary with the aim of providing evidence based patient care. No significant financial relationships to disclose.

T05-P-11 Sexual activity in patients with long-term urethral catheter

Objective The literature data regarding sexual activity in patients with permanent urethral catheter is scarce. Our study aimed to evaluate the particularities of sexual habits in these patients. Design and method We evaluated the sexual activity of 321 male patients with long-term (more than 12 months) urethral catheter that were referred between January 1996 and June 2007 to our department for various urologic pathologies. All patients received a questionnaire in which were asked about the presence of any sex-related activity and were asked to describe it. All patients were also evaluated regarding the quality of life (QoL score). Results Only 304/321 patients (94.7%) chose to respond to our questionnaire. 211/304 patients (69.4%) reported no sexual activity during the period of urethral catheterization. 81/304 patients (26.7%) described some sexual-related activity but without any intercourse. 79 of these 81 patients had stable female partners. 12/304 patients (3.9%) reported sexual intercourse, all of them with stable female partners. Regarding sexual intercourse 10 of them had the urethral catheter removed temporarily and being catheterized by the female partner after the act. Two of these patients described sexual intercourses with the catheter. The sexual active patients had a mean QoL score with 1.2 points higher than those with no such activity. Conclusion The presence of sexual activity in patients with long-term urethral catheterization seems to improve the quality of life. This kind of sexual activity occurs usually in stable couples in which the female partner is indulgent and receptive to innovative solutions

Perceived influence of health status on sexual activity in RA patients: associations with demographic and disease‐related variables

Objective: To examine the prevalence of self‐reported problems with sexual activity in patients with rheumatoid arthritis (RA), and associations with demographic and disease‐related variables.Methods: Perceived levels of problems with sexual activity were addressed through question 15 of the Health‐Related Quality of Life (HRQoL) instrument 15D. Disease‐related variables were determined with the Visual Analogue Scale (VAS), the Arthritis Impact Measurement Scale (AIMS2), the Health Assessment Questionnaire (HAQ), and the Arthritis Specific Self‐Efficacy (ASES) questionnaire.Results: Data were available from 830 patients with RA 74% female, mean (SD) age 58.5 (14.2) years, disease duration 13.4 (10.3) years, HAQ score 0.98 (0.72). No impact on sexual activity was reported by 31%, little by 38%, considerable by 21%, 3% reported sexual activity as almost impossible, and 7% reported sexual activity as impossible. When dichotomized, the ‘large impact’ group had worse health status across all dimensions compared to the group with ‘no/little impact’ (p<0.001). In the multiple logistic regression analyses, perceived impact on sexual activity was associated with male vs. female gender [odds ratio (OR) 3.18, 95% confidence interval (CI) 2.05–4.94], age (youngest vs. oldest group) (OR 3.56, 95% CI 1.78–7.09), increased levels of fatigue (OR 1.01, 95% CI 1.0–1.02) and mental distress (OR 1.21, 95% CI 1.06–1.38), HAQ score (OR 2.46, 95% CI 1.78–3.39), and low self‐efficacy regarding symptoms (OR 0.97, 95% CI 0.96–0.98).Conclusion: One‐third of the RA patients reported that their health status considerably influenced their sexual activity. Higher levels of fatigue, mental distress, functional limitations, lower levels of self‐efficacy, and male gender were independently associated with perceived problems with sexual activity.

Female Sexual Dysfunction in Urogenital Prolapse Surgery: Colposacropexy vs. Hysterocolposacropexy

Colposacropexy (CSP), with or without hysterectomy, is a valid technique for the repair of severe urogenital prolapse. For many years, uterine prolapse has represented an indication for hysterectomy, apart from the presence or absence of uterine disease and the patient's desires. Nevertheless, sparing the uterus is essential to women not only to have normal sexual functioning but to maintain physical and anatomical integrity as well. To assess sexual function in a group of patients who underwent CSP or hysterocolposacropexy (HSP). We enrolled 37 patients who underwent surgery for urogenital prolapse (15 HSP, mean age 53 years; 22 CSP, mean age 56 years). Based on a preliminary sexual history and sexual questionnaire, all patients were sexually active before surgery. At a mean follow-up of 39 months, we reassessed the patients using the Female Sexual Function Index (FSFI). We considered sexual activity with a score of 30 = good, 23-29 = intermediate, and <23 = poor. In patients who underwent CSP and HSP, sexual activity was good in 13% and 26%, intermediate in 33% and 21%, and poor in 54% and 53%, respectively; considering also five patients who no longer had sexual activity postoperatively. Nevertheless, the statistical analysis, performed based on the data obtained from the FSFI questionnaire, showed that there were no significant differences between the two groups of points in terms of total score-CSP 21.1 (1.2-33.5) vs. HSP 22.8 (3.6-34.5)-and single domains (desire, arousal, lubrication, orgasm, satisfaction, and pain) (P = not significant). Our data demonstrated no substantial differences regarding sexual activity in patients in which the uterus has been spared as opposed to those in whom it has been removed. Furthermore, in a small percentage of cases, surgery actually reduced regular sexual activity.

Sexual function before and after primary total hip arthroplasty

Objectives Chronic hip pain can have an impact on the sexual activity of patients, all the more so if they are young. Methods Our department undertook a retrospective study using a questionnaire mailed out to 135 patients (58 women and 77 men) under 65 years of age who had undergone a total hip replacement (THA) with primary implant more than 6 months previously. The mean age of the patients was 51.8 years (22–65 years). Results The age at which sexual difficulties first occurred was on average 45 years (21–63 years), or a mean of 2.5 years after the appearance of hip pain. Nineteen percent of patients considered their sexual difficulties to be severe to extreme. This caused tension or unhappiness in their relationship for 7% of patients. The cause for the difficulty was generally pain followed by stiffness. The patients with the most marked and earliest disorders were young women with hip dislocating anomalies. Multiarticular damage (Charnley C) is a factor which is conducive to difficulties. For patients, total hip replacement is associated with an improvement in sexual relations. The frequency of relations is increased in significantly more women than men, where this is associated with a change in positions practised. Only 17% of patients benefited from information concerning sexual activity after THA (time to resumption and/or at-risk positions). Conclusions Sexual difficulties should therefore be taken into account by medical staff, and in particular by the surgeon. He should supply clear information. The subject should not be marginalized and, on the contrary, should be taken into account in the pre- and postoperative assessment.

New onset heightened interest or drive for gambling, shopping, eating or sexual activity in patients with Parkinson's disease: the role of dopamine agonist treatment and age at motor symptoms onset

Alterations of impulse control that have recently been associated with Parkinson's disease (PD) are serious behavioural disturbances with significant impact on PD patients and their families.A total of 193 consecutive PD patients with no history of psychiatric illness and 190 age/gender-matched healthy controls were queried on the presence of new onset heightened interest or drive for gambling, shopping, eating or sexual activity (GSES). Clinical data were retrieved from medical charts and interviews. logistic regressions models assessed risk factors for these specific troublesome behaviours. New or heightened interests or drives for GSES behaviours were reported by 27 patients (14% vs 0% for controls). Younger age at PD motor symptoms onset (OR = 0.99, p = 0.0172), male gender (OR = 1.10, p = 0.0576) and longer duration of treatment with dopamine agonists (DAs)(OR = 1.18, >/=6 years versus never treated, p = 0.0459) contributed additively to the risk of developing one or more of these behavioural features. New onset heightened interests or drives for GSES are not rare behavioural disturbances among patients with PD. Age, gender and duration of treatment with DAs have an independent and additive effect on the risk to develop such behavioural changes. Patients should be informed about potential treatment-associated behavioural changes.

Efficacy and Safety of Two Dosing Regimens of Tadalafil and Patterns of Sexual Activity in Men with Diabetes Mellitus and Erectile Dysfunction: Scheduled Use vs. On‐Demand Regimen Evaluation (SURE) Study in 14 European Countries

The aim of this article is to evaluate the efficacy and safety of 20-mg tadalafil taken on demand or three times per week and its effect on the sexual activity of patients with diabetes mellitus and erectile dysfunction (ED). The scheduled use vs. on-demand regimen evaluation (SURE) was a randomized, crossover, open-label study with 4,262 patients in 14 European countries. The efficacy measures for the 762 patients with diabetes and ED included changes from baseline in the erectile function (EF) domain of the International Index of Erectile Function (IIEF), and the proportion of "yes" responses to patient Sexual Encounter Profile (SEP) questions 2 (SEP2) and 3 (SEP3). The treatment satisfaction was measured with responses to SEP question 4 (SEP4) and SEP question 5 (SEP5), and sexual attempts data were collected. Patient preference for either regimen was determined by the treatment preference question (TPQ). At end point on both regimens, the mean IIEF EF domain score was 22, and >40% of the patients had a normal EF domain score (> or =26). The proportion of "yes" responses was > or =73% for SEP2 (penetration), > or =58% for SEP3 (successful intercourse), >46% for SEP4 (hardness of erection), and > or =45% for SEP5 (overall satisfaction). Efficacy was maintained up to 36 hours post-dosing. More than 70% of sexual attempts while on the three-times-per-week regimen and approximately 50% of the attempts on the on-demand treatment occurred >4 hours post-dosing. Tadalafil was well tolerated, with dyspepsia and headache as the most frequent adverse events reported. Treatment preference was 57.2% for on demand and 42.8% for three times per week. Tadalafil, when taken on demand or three times per week, is efficacious and safe in men with diabetes and ED.

O-111. Switching to anastrozole (ANA) vs continued Tamoxifen (TAM) treatment of early breast cancer (EBC). Updated results of the Italian Tamoxifen Anastrozole (ITA) trial

Women with breast hypertrophy often experience a number of physical symptoms and psychological difficulties. The breasts are very important for the psychological well-being of women, which might be affected negatively because of breast size and shape distortions. Self-body dissatisfaction and, in this background, the breasts can lead to low levels of self-confidence and self-esteem, which might affect sexuality.Thirty-five women with macromastia and their partners were evaluated for their sexual function and surgery satisfaction before and 6 months following reduction mammaplasty. Physical status and sexual satisfaction were assessed using a questionnaire. In addition, the sexual function of the women and their partners was evaluated using the Index of Female Sexual Function (IFSF) and the International Index of Erectile Function (IIEF).There was a significant improvement in the mean IFSF and IIEF scores after surgery in both patients and their partners. In addition, patients expressed high levels of satisfaction with the results of surgery in terms of physical and psychological scores.Reduction breast surgery has a positive impact on the health status and psychological function as well as on the sexual activity of patients and their partners.

Comparison of trimetazidine plus sildenafil to chronic nitrates in the control of myocardial ischemia during sexual activity in patients with coronary artery disease

A large proportion of patients who have erectile dysfunction also have coronary artery disease (CAD). In these patients, nitrate therapy is a contraindication to the use of sildenafil. To assess whether the metabolic anti-ischemic agent, trimetazidine, is effective in controlling episodes of myocardial ischemia during sexual activity in patients who have CAD and use long-term nitrate therapy, we studied 38 men (57 +/- 6 years of age) who had proved CAD. Patients underwent 24-hour ambulatory electrocardiographic monitoring at baseline, after 1 week of oral nitrate therapy (20 mg 3 times a day), and after 1 week of trimetazidine (20 mg 3 times a day). Patients were asked to engage in >/=1 session of sexual intercourse during each session of ambulatory electrocardiographic monitoring. They were instructed to take sildenafil (100 mg) 1 hour before sexual intercourse performed at baseline and during therapy with trimetazidine and sildenafil or placebo (blinded) during therapy with nitrates. A decrease in total ischemic burden was observed with nitrates and trimetazidine compared with baseline (-3 +/- 1.2 episodes/patient/24 hours vs -5 +/- 1.3 episodes/patient/24 hours and -6 +/- 5 min/patient/24 hours vs -8 +/- 3 min/patient/24 hours, p <0.01 for nitrates and trimetazidine vs baseline). Trimetazidine plus sildenafil was more effective in controlling episodes of myocardial ischemia during sexual activity than nitrates alone (-45 +/- 11% vs -18 +/- 7%, p <0.04). In conclusion, in patients who have CAD, combination therapy with sildenafil and trimetazidine is more effective than nitrate therapy in the control of ischemic episodes during sexual activity, suggesting that long-term nitrate therapy may be safely switched to trimetazidine therapy when therapy for erectile dysfunction is required.

Sexual dysfunction and chronic pain: the role of psychological variables and impact on quality of life

We report two studies examining the prevalence of sexual dysfunction, and the role of psychological variables, including quality of life, on sexual activity in patients at the commencement of an outpatient cognitive–behavioural pain management programme. In Study 1, 151 patients with non-cancer pain, predominantly of musculoskeletal origin, completed a range of standardised measures, including the Pain Disability Index, Beck Depression Inventory and Coping Strategies Questionnaire. Sexual dysfunction was common, and using stepwise multiple regression analysis was found to be more frequently reported by those with greater disability and depression, shorter pain duration, and infrequent use of coping self-statements. Study 2 was a pilot investigation of the impact of sexual dysfunction on quality of life (as measured by the WHOQOL-100) in a similar sample ( n = 41). Although sexual dysfunction was again commonly reported, subjects perceived it had less importance in quality of life than did other factors. The combined results support the previously proposed notion of adaptation to the impact of chronic illness on sexual function. In conclusion, sexual dysfunction is common in this population and is predicted by psychological factors and pain duration. However, other issues impact more significantly on quality of life. Therapeutic approaches to sexual dysfunction in these patients might best be focused on improving psychological factors, particularly depression and coping skills.

Evaluation of Sexual Activity in Patients Treated with Tadalafil: A Randomized Prospective Placebo-Controlled Trial

Evaluate the chronological distribution of sexual intercourses in a group of patients treated with Tadalafil versus placebo for three months. Methods 120 patients with ED were randomized in two groups and treated respectively with one pill of Tadalafil 20mg or placebo on Tuesday and on Friday. After three months we collected data using IIEF and SEP diaries. Results After three months, IIEF score and percentages of success SEP diaries increased in Tadalafil group (&lt; 0.01) versus Placebo group. Considering all the successful intercourses of the three months of Tadalafil assumption, the highest percentages were reported within 6–12 hours range (35%) and 12–24 hours range (28%). In Tadalafil group, 41% of patients reported their first successful intercourse between 1–6 hours and 78% of patients reported the recovery of spontaneous erections. Conclusions After doing the first sexual attempt between 1–6 hours, patients engaged in sexual activity between 6–24 hours.

Evaluation of sexual activity in patients treated with tadalafil: a randomized prospective placebo-controlled trial

The chronological distribution of sexual intercourses in a group of patients treated with tadalafil versus placebo for 3 months was evaluated. In total, 120 patients with ED were randomized in two groups and treated, respectively, with one pill of tadalafil 20 mg or placebo on Tuesday and on Friday. After 3 months, we collected data using IIEF and SEP diaries. After 3 months, IIEF score and percentages of success SEP diaries increased in the tadalafil group (<0.01) versus placebo group. Considering all the successful intercourses of the 3 months of tadalafil assumption, the highest percentages were reported within 6-12 h range (35%) and 12-24 h range (28%). In tadalafil group, 41% of patients reported their first successful intercourse between 1 and 6 h and 78% of patients reported the recovery of spontaneous erections. In conclusion, after carrying out the first sexual attempt between 1 and 6 h, patients engaged in sexual activity between 6 and 24 h.

Sexual activity in patients with angina.

COITAL ANGINA IS ANGINA THAT occurs during the minutes or hours following sexual activity. More than 6 million individuals in the United States experience angina pectoris. Coital angina appears to represent less than 5% of all anginal attacks. For various reasons, fewer middle aged or older women engage in sexual activity than age-matched men. Accordingly, the prevalence of coital angina is higher in men than in women. The comparative physical demands of sexual activity in men and women are unknown. Frequency of coitus diminishes with age in both women and men, especially after the onset of coronary artery disease, which occurs some 10 years later in women than in men. Coital angina is rare in patients who do not have angina during strenuous physical exertion. It is more prevalent in sedentary individuals with severe coronary artery disease who experience angina with minimal physical activity. Among these sedentary individuals, myocardial oxygen demand during coitus may exceed that during customary activities of daily living; for these individuals, sex may be a provocative test.

A SYSTEMATIC APPROACH TO ERECTILE DYSFUNCTION IN THE CARDIOVASCULAR PATIENT: A CONSENSUS STATEMENT – UPDATE 2002

EXECUTIVE SUMMARY Sexual activity is no more stressful to the heart when compared with a number of other natural daily activities, e.g. walking one mile on the level in 20 minutes. The cardiac risk of sexual activity in patients diagnosed with cardiovascular disease is minimal in properly assessed and advised patients. Erectile dysfunction (ED) is extremely common, affecting over half of men aged 40–70 years, and increases in frequency with age. ED and cardiovascular disease share many of the same risk factors and commonly coexist. ED in the otherwise asymptomatic man may be a marker for underlying coronary artery disease. ED in the diagnosed cardiovascular patient should be identified by routine questioning in general practice. Modern therapies can restore a sexual relationship in the majority of patients with ED and can lead to a substantial improvement in quality of life. The majority of patients assessed to be at low or intermediate cardiac risk, as defined later in this paper, can be effectively managed in primary care. Primary care treatment for ED in patients defined as high risk can be initiated following a specialist opinion and/or confirmation that the patient's cardiovascular condition is stabilised. There is no evidence that currently licensed treatments for ED add to the overall cardiovascular risk in patients with or without diagnosed cardiovascular disease. If one form of therapy is not effective, follow‐up will identify the need for alternative approaches. The pro‐active management of ED in the cardiovascular patient provides an ideal and effective opportunity to address other cardiovascular risk factors and improve treatment outcomes.

Voiding function and sexual activity in patients following Hautmann neobladder construction

We retrospectively evaluated the outcome of Hautmann neobladder reconstruction in terms of complications, lower urinary tract symptoms, and sexual function in a large group of patients who underwent radical cystectomy. We reviewed the medical records of 118 patients (105 men and 13 women) who underwent radical cystectomy and Hautmann neobladder construction at the Gifu University Hospital or one of its affiliate hospitals between Jan 1993 and Dec 1999. The 118 patients were asked to complete a questionnaire regarding lower urinary tract symptoms and sexual activity, and the data was compiled. The mean follow-up period was 50.4 months (range, 6.8-88.2). Early complications comprised wound infection (in 17.8% of patients) and ileus (in 10.1% of patients). Late complications comprised ileus, pyelonephritis, stone, and stricture of the pouch-urethral anastomosis, each of which occurred in 3.4% of patients. Eighty-one (73 men and 8 women, 72.9%) of 90 surviving patients replied to the questionnaire. Seventy-seven (95.1%) of these patients reported spontaneous micturition, whereas 4 (4.9%) patients required intermittent self-catheterization. The mean total I-PSS was 11.6 points. Twenty-five percent of patients experienced interrupted voiding almost always; 38% of patients did not experience this at all. Approximately 26% of patients experienced weak urinary streams; 36% did not. Daytime continence was achieved in 97.3% of patients; nighttime incontinence was present in 61.3%. Preoperatively, 79.7% of the men were capable of sexual intercourse. Postoperatively, 63.6% of men who underwent radical cystectomy with the nerve-sparing procedure were capable of sexual intercourse, whereas only 14.8% of men who underwent radical cystectomy without the nerve-sparing procedure were. Morbidity rates were acceptable and functional outcome was excellent in this rather large group of patients who underwent Hautmann neobladder construction. Some problems have not been fully overcome, however, i.e., nocturnal incontinence and sexual dysfunction.

Sexual difficulties of chronic pain patients.

Description of the specific physical and psychological problems associated with sexual activity in patients with chronic pain. Self-completion questionnaire on extent and nature of sexual difficulties related to pain; data on psychological and physical function in respondents; personal and medical data for respondents and nonrespondents. Three hundred twenty-seven patients with chronic pain in inpatient and outpatient pain programs; 237 (72%) completed the questionnaire. Extent of general and specific sexual problems; anxiety and depression (Hospital Anxiety and Depression Scale [HAD]); pain self-efficacy; pain-related disability (Sickness Impact Profile); drug use. Respondents were younger and had less depressed mood than nonrespondents, but there were no other major differences. Seventy-three percent of respondents had pain-related difficulty with sexual activity; most had several, in various combinations of problems with arousal, position, exacerbating pain, low confidence, performance worries, and relationship problems. All except position difficulties were associated with less frequent sexual activity. There were few differences between men and women, and only weak relations emerged between specific problems and mood and disability. There is a high prevalence of sexual difficulties in patients with chronic pain attending treatment, nearly double that of a general UK survey. These difficulties are not simply related to mood or disability. The range of problems and patients' expressed preferences for help suggest that multidisciplinary intervention is required.

How should doctors talk to teen patients?

Doctors can be intimidating to teens and it is important to help them tell you what's on their mind. Health care practitioners caring for adolescents should follow these tips on how to talk to their teen patients. Remind your patients that, by law, you cannot disclose anything discussed between you and your patient. This will make teens feel more comfortable talking to you. Don't be shocked (or at least show your shock). It is difficult for a teen to talk to a doctor who looks shocked. Just because you've never met a pregnant 10 year old does not allow you to look her in the eye with a stunned look and say nothing. (This tip is especially helpful in the case of problems to do with sex.) Let your patient know, through both body language and words, that they can discuss anything with you. Teens need to know that their doctor is accessible to them. Doctors, in my experience, refrain from discussing their patients' sexual pasts with them. This is probably because any adult, or anyone for that matter, is uncomfortable hearing about anyone's sex life, especially an adolescent's. Not until I began visiting the doctors at college did a doctor ask me about my sexual activity without my prompting a question that would lead them to ask. When a patient comes for a simple check-up, doctors should make sure that their patient is entirely healthy. A good way to make sure is to ask about their patient's sexual activity. Believe what their patients say. On one occasion, a doctor who asked me if I was pregnant, did not listen to me when I told him that I was not sexually active, and kept pressuring me. Unless you are absolutely sure that a patient is not being truthful, do not prod them into telling you what you want to hear. If a parent is present in the exam room, ask them to leave or ask your patient if they would prefer to have their parent(s) present or not. If a parent is either present or not, it can change the patient's comfort level, and change whether or not you hear what is actually bothering the patient. Treat teen patients in a way that is right for their age. Because most teens still see pediatricians, many pediatricians make the mistake of talking to their teen patients like the 4 year olds they treat. Teens are almost adults, and like to be treated like they are adults. Parents and doctors should explain the procedure of a pelvic examination and their feelings and experiences with it so that the teen understands that other people have survived them. Also, one important thing to tell patients ahead of time is that a female nurse must be present during the procedure when the examination is performed by a male doctor. Many of my friends have made gynecologic appointments and have been seen by male doctors. They have been scared of being seen by men and are frightened of molestation. Knowing before the examination that by law a woman must be present can calm the patient.