Sexual Wellbeing

Question 1

How to intro discussion….

Answer 1

I ask people whether they are having any sexual or relationship difficulties in this clinic as it is an important part of overall health. ….

Question 2

Why genital examination?

Answer 2

Physical causes for sexual problems
Reassurance of a normal exam
May helpfully appreciate pt behaviours/ attitude

Offer it and ask if want you to explain if not had before/talk through it or at end. They can tell you when ready to start.

Question 3

Tests and examination in ED?

Answer 3

BP
HR
BMI

Examination essential if deviation erection (Peyronies) , rapid onset pain, urological symptoms (prostate consider PR)
Look for small testes (hypogonadism)
Gynaecomastia/reduced body hair

Bloods hba1c, lipids, morning T

If low T repeat + FSH LH prolactin

Question 4

Management ED

Answer 4

Lifestyle
Med r/v
If cycling 3+ hrs try reducing

PDE-5 inhibitors eg sildenafil OTC/no restrictions others in certain circumstances.

Alprostadil injection/urethral

Mechanical erection devices

Psychosex or CBT if relevant

T only if hypogonadism

Prostheses

Question 5

Management of Premature/Rapid ejaculation

Answer 5

Behavioural eg stop-start
Topical anaesthetic
Psychosex (often performance anxiety)
Dapoxetine (short acting SSRI)

Question 6

Management delayed/absent ejaculation

Answer 6

Consider medications on eg SSRI alpha blockers
Neurological disease
Pain
Diabetes
Inhibition or anxiety