Skip to main content
main-content
Top

18-09-2018 | Sexual dysfunction | View from the clinic | Article

Regaining sexual health in diabetes: Start with open communication

Author:
Clipper Young

Author bio | Disclosures


“I can’t make love to my wife anymore...”


These were the words of a patient during a routine diabetes consultation at my clinic. The patient had a history of myocardial infarction and was (rightly) worried about the risks of taking sildenafil (Viagra®), which he had previously been prescribed.

In this instance, it was clear that the patient was reaching out for help to preserve his psychological health, quality of life, and relationship with his wife. The encounter inspired this view from the clinic as I recognized, all too well, that initiating the conversation about sexual dysfunction is seldom this straightforward for clinician or patient.

The communication divide

Barriers for patients

It is both unsurprising and understandable that many patients are reluctant to discuss sexual health problems such as erectile dysfunction (ED) during routine visits. The perception that the issue represents a failure on the part of the individual can be a powerful deterrent, despite the prevalence of sexual dysfunction in people with diabetes. Hence, I believe that it is crucial that we – the healthcare team as a whole – take the initiative to at least start a dialog with our patients to bridge the communication divide that arises around sexual health problems.

Barriers for clinicians

In my experience, ED rarely features as a discussion topic for busy primary care providers. Some are concerned that ED is too complex to manage properly under the time pressure, while others feel that they lack the appropriate knowledge and skills to address the issue. In spite of this, I strongly believe that primary care providers have an important role in initiating open communication, with a view to establishing an effective treatment plan with a specialist.

Bridging the gap


“Other than what you are coming in for, are there any sexual health concerns you would like to discuss?”


A quick review of a patient’s medical record can highlight conditions and medications associated with ED; this insight can serve as a useful prompt for the question above. By posing a similar question casually, at the start of the visit, you invite the patient to “meet in the middle” and give way to the prospect of an in-depth and honest discussion about their concerns, with the possibility of arriving at an initial plan for treatment.

Treatment options

Advances in medicine have yielded a multitude of treatment options to fit the needs and comfort level of patients at different ages with various preferences. Summarized below are some of the main options available to patients with ED, in the USA.

Common ED treatments
Oral medications
Sildenafil (Viagra®)
Vardenafil (Levitra®)
Tadalafil (Cialis®)
Urethral suppository
Alprostadil (MUSE®)
Injection
Alprostadil (Caverject Impulse®)
Non-pharmacological options
Constriction bands
Vacuum pumps
Penile support sleeves
Penile implant

Patients faced with such a wide variety of treatment options are likely to require an in-depth discussion to support them in making an informed choice. While the responsibility for guiding the patient typically lies beyond primary care, clinicians in this position have a vital responsibility to educate the patient and facilitate the kind of open communication that will eventually lead to a urology referral.

The referral and beyond

Comprehensive approaches for treating ED will normally be guided by a urologist. With their specialized training on the condition, and diverse interdisciplinary connections, urology teams are best placed to oversee a diabetes patient’s chosen/recommended treatment for ED. I have found that it is good practice to suggest having the partner accompany the patient to the urology consultation. In this way the treatment decision, which potentially impacts the dynamics of the couple, can be made as a team and bring them closer to their desired outcome(s).

Putting communication into practice

For the aforementioned patient, open communication was established. I, as a Certified Diabetes Educator (CDE), was able to provide the appropriate educational resources for him to consider, thus encouraging him to continue seeking a treatment option that would best suit him. Open communication – between patient and clinician, and between patient and partner – is the first and most fundamental step in tackling issues associated with ED and regaining sexual health in diabetes.

Recommended reading

  • Roszler J, Rice D. Sex and Diabetes: For Him and For Her. Alexander, VA, USA: American Diabetes Association, 2007.
  • Hackett GI. What do patients expect from erectile dysfunction therapy? Eur Urol 2002; 1(8): 4–11.
  • Sadovsky R. The role of the primary care clinician in the management of erectile dysfunction. Rev Urol 2002; 4(Suppl 3): S54–S63.

Related topics

Best communication practices for subspecialty referrals

Author: Jay Shubrook
Author bio | Disclosures

Professional communication, now more than ever, is central to chronic disease management. Most patients with chronic disease will have numerous healthcare providers who contribute to their care, including the patient’s primary care health team, disease subspecialists, and possibly allied health professionals.

To provide the best possible patient-centered care, coordination and communication among the healthcare team is paramount. A lack of either can result in missed handoffs and may blur the lines of responsibility for each aspect of care.

I have had the honor to serve both as a primary care physician and as a diabetes specialist. This has allowed me to see the keys to patient communication from multiple sides. I have the greatest respect for primary care providers who have to handle the entirety of a patient’s health, and will not only manage many medical problems at one time but also balance them in the context of family, community, and culture. Similarly, the subspecialist’s knowledge and in-depth experience of rarer forms of diabetes and its complications are critical to proving the optimal patient care.

Below, I have summarized a few key considerations for the generalist and the specialist, which I believe will help get the best out of any diabetes-related referral.

Related content

Related content