04/06/2015. Aaron V. Sapp, MD, MBA University of Missouri Columbia Student Health Center

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1 Aaron V. Sapp, MD, MBA University of Missouri Columbia Student Health Center 1

2 Men Women 20.6% Talked to doctor 18.2% Talked to doctor 79.4% Did not talk to doctor 81.8% Did not talk to doctor Lack of opportunity Sense of embarrassment and shame Societal taboo against the open discussion of sexuality Not feeling optimistic about the outcome of such a discussion Uncertain whether sexual problems/concerns are part of health care Uncertain which specialty treats sexual problems/concerns 2

3 Time constraints Unrealistic fear of offending the patient Deficits in communication skills Reimbursement concerns Lack of available or approved treatments Growing knowledge gap between developments in sexual medicine and the clinical skills of the clinician Discomfort about asking sexual questions to a patient of the opposite gender Discomfort about asking sexual questions to a patient under age 18 or over 65 Inadequate training in sexual health 3

4 The purposes of sexual health care should be the enhancement of life and personal relationships, and not merely counselling and care related to procreation or sexually transmitted infections Prevalence Prevalence Syphilis Gonorrhea Other concern (men) Other concern (women) 4

5 In the past, well all my life, sex has been a dominant, not dominant, but very important part of me when it does not function like I would like for it to, it kind of diminishes me. 5

6 Consider: have you had recent sexual contact with another person? Doctor, I think I need a check up Yes, of course, It s quite a time since the last one. let me start with your blood pressure 6

7 Doctor, I think I need a check up Check up: Yes, I m not performing as well as I used to: Performing? Yes, well, you know, I think I m impotent. My wife is very good about it and doesn t complain, but I feel so guilty and ashamed Ashamed? I feel terrible. I don t feel a man any more, especially as we used to have such a good sex life start at the beginning when this first bothered you and tell me the story that ends up with you deciding to talk to be about it. 7

8 Example 1 Questions for a Detailed Sexual History Are you currently sexually active? Have you ever been? Are your partners men, women, or both? How many partners have you had in the past month? Six months? Lifetime? How satisfied with your (and/or your partner's) sexual functioning are you? Has there been any change in your (or your partner's) sexual desire or the frequency of sexual activity? Do you have, or have you ever had, any risk factors for HIV? (List blood transfusions, needlestick injuries, IV drug use, STDs, partners who may have placed you at risk.) Have you ever had any sexually related diseases? Have you ever been tested for HIV? Would you like to be? What do you do to protect yourself from contracting HIV? What method do you use for contraception? Are you trying to become pregnant (or father a child)? Do you participate in oral sex? Anal sex? Do you or your partner(s) use any particular devices or substances to enhance your sexual pleasure? Do you ever have pain with intercourse? Women: Do you have any difficulty achieving orgasm? Men: Do you have any difficulty obtaining and maintaining an erection? Difficulty with ejaculation? Do you have any questions or concerns about your sexual functioning? Is there anything about your (or your partner's) sexual activity (as individuals or as a couple) that you would like to change? HIV = human immunodeficiency virus; IV = intravenous; STDs = sexually transmitted diseases. Example 2 12 key sexuality questions for clinicians 1 On a scale of 1 to 10, how would you rate your sex life? (1 is very poor and 10 is the best it could be.) For it to be a 10, what would have to change? 2 How would you describe your level of sexual desire? 3 [Women] Do you lubricate? 4 [Men] Do you have difficulty getting and keeping an erection? Do you have morning/nocturnal erections? 5 Is achieving orgasm difficult for you? When you have sex, what proportion of the time do you achieve orgasm? 6 How pleasurable are your orgasms? 7 [Men] Is ejaculating too soon during intercourse a problem for you? 8 Approximately how long does it take you do achieve orgasm? 9 Do you have pain or discomfort during intercourse? 10 How long have you had this problem? 11 Does anything make it better or worse? 12 How frequently do you have sexual intercourse/other forms of sex? 8

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