VIENNA — Sexual dysfunction in patients with gastrointestinal disorders is undermanaged, with a lack of clinician education, time constraints, and embarrassment preventing constructive discussions to improve patient care and quality of life, according to a new survey.
Overall, 71% of gastroenterologists do not ask their patients about sexual dysfunction, the survey finds.
“While patients with gastrointestinal disorders often experience sexual dysfunction, discussions around the matter are not routine in gastroenterological care,” said Marco Romano, MD, from the University of Campania “Luigi Vanvitelli,” Naples, Italy.
Romano presented the survey findings at this year’s United European Gastroenterology (UEG) 2022 meeting.
The research shows not only a clear need for better awareness but also a need to build gastroenterologists’ confidence in addressing sexual dysfunction with their patients, Romano added.
“Most felt that sexual medicine education and improvement of communication skills within the context of their residency training might be important in order to increase the awareness of sexual dysfunction, to overcome barriers, and to improve care and quality of life for their patients,” reported Romano. “This will lead to prompt diagnosis and treatment of any sexual problems.”
Respectfully asking the patient if their gastrointestinal disorder interferes with their intimate relationships “is often considered a relief to patients who find that the gastrointestinal problem and the sexual dysfunction are interlinked,” he added.
The survey was needed because the question of whether gastroenterologists inquire about their patients’ sexual issues had never been assessed, Romano said.
The researchers sent a cross-sectional, anonymous online survey to members of the Italian Society of Gastroenterology and Digestive Endoscopy. The questionnaire, designed and informed by a literature review, consisted of 29 single multiple-choice and open-ended questions.
A total of 426 surveys were returned, with 335 from experienced gastroenterologists and 91 from residents (less experienced). Of all respondents, 54.7% were men and 45.3% were women.
Even though most gastroenterologists do not ask their patients about sexual dysfunction, the majority want to learn how to manage the issue, the survey finds. Of the survey respondents, 80% agree that it would be useful for gastroenterologists to attend courses dedicated to the problem of sexual dysfunction.
Only 4% of patients report (initiate a dialogue) the the problem, the survey finds. Among women aged 40-50 years, the most common complaint reported was dyspareunia (pain on intercourse). In men, the most frequent complaints reported were in the over-40s age group, with 75% reporting erectile dysfunction and 45% reporting loss of libido.
The most common gastrointestinal disorders associated with sexual dysfunction are inflammatory bowel diseases (37% of cases), chronic liver diseases (28%), and irritable bowel syndrome (26%), the survey finds.
The survey asked whether clinicians felt medications played a role in patients’ sexual dysfunction. Nearly 15% of respondents said that prokinetic agents were involved, and 18% thought proton pump inhibitors affect sexual function. Both drug classes are considered responsible for sexual disturbances.
Few gastroenterologists prescribe phosphodiesterase type 5 inhibitors (PDE5i), eg, Viagra, to treat sexual dysfunction, the survey finds. Approximately 90% of respondents said that they never prescribed this class of drugs, preferring to refer patients to an andrologist. Of those who do prescribe PDE5i, significantly fewer residents did than did experienced gastroenterologists (1.1% vs 8.8%, respectively; P = .01).
Finally, the biggest reasons why gastroenterologists do not discuss sexual dysfunction are lack of knowledge (80%), insufficient experience (58%), time (44%), and embarrassment (30%).
Practice Experience Matters
There were some differences among respondents in the experienced group vs the residents. More men were in the experienced group compared with residents (57.6% vs 44%, respectively); mean age was 47 years vs 29 years, respectively; and 71% had 5 or more years of experience in the experienced gastroenterologist group, whereas 78% had 1-5 years of experience among residents.
The survey found that more residents than experienced gastroenterologists “never discussed sexual dysfunction” (38.5% vs 21.3%, respectively; P = .001) and that more residents than experienced gastroenterologists reported that “patients did not relate their sexual dysfunction to the prescribed therapy” (47.8% vs 32.5%, respectively; P = .007).
The two groups also varied regarding prescription drugs’ role in sexual dysfunction. More experienced gastroenterologists than residents felt that proton pump inhibitors (5.8% vs 0%, respectively; P = .018) or prokinetics (19.8% vs 9.5%, respectively; P = .028) might be responsible for some degree of sexual dysfunction.
More residents than experienced doctors felt that other (nongastroenterologic) drugs might contribute to sexual dysfunction in their patients (57.1% vs 44.7%, respectively; P = .043).
Romano reported that fewer residents than experienced gastroenterologists referred male patients with sexual dysfunction to an andrologist (frequently/always: 28.1% vs 44.4%, respectively; P = .004). However, more residents than experienced gastroenterologists disagreed that discussing sexual dysfunction with patients only pertains to specialists (andrologists and gynecologists; 83.5% vs 71.2%, respectively; P = .018).
Time to Step Up
Asma Fikree, BMBCh, MA, MRCP, PhD, from the Royal London Hospital, Barts Health NHS Trust, London, United Kingdom, moderated the session. The survey highlights that asking patients about sexual dysfunction is an area for improvement for gastroenterologists, she said.
“We might do it in men and ask about erectile dysfunction, but we are very poor about asking in women,” Fikree noted.
The pros and cons of different medications should be discussed with patients, she said.
Gastroenterologists need to do a better job of considering how medications can lead to sexual dysfunction and interfere with quality of life, and training would help, she added.
“Some patients might not be very bothered by sexual dysfunction, but others might consider it very important,” Fikree said. “We should be considering this as part of their treatment and care.”
United European Gastroenterology (UEG) 2022: Abstract OP012. Presented October 9, 2022.
Romano and Fikree report no relevant financial relationships.
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