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GPs fail on ED diagnoses, says study

Up to 13% of men in the UAE with erectile dysfunction (ED) go undiagnosed because of a lack of physician-initiated inquiries into sexual health, suggests a new survey.

Up to 13% of men in the UAE with erectile dysfunction (ED) go undiagnosed because of a lack of physician-initiated inquiries into sexual health, suggests a new survey.

The Global Better Sex Survey, sponsored by Pfizer, compiled interviews with 12,563 men and women across 27 countries.

The survey found that 54% of UAE men were identified as having suboptimal erections, in accordance with the four-grade QEQ scale. However, only 41% of men self-identified as having erectile dysfunction, suggesting that a significant number of sufferers remain untreated.

The GBSS results were announced at the 12th World Congress of the International Society of Sexual Medicine, held in Cairo.

Dr Rosie King, of the Australian Centre for Sexual Health at St Luke’s Hospital, Sydney, was a key consultant on the study. She believes physician reluctance is a key factor in the
under-diagnosis of ED.

“The discomfort level physicians have in discussing sex with patients should not be underestimated,” she said.

“GPs don’t want to appear intrusive, but they should recognise that ED is very common.”

Previous studies have revealed a ‘lack of time’ or belief that the ‘patient will initiate discussions’ was cited by several practitioners as reasons why inquiries were not initiated.

The under-diagnosis of ED is particularly concerning, as the condition can indicate wider and more serious health issues. A 2005 study in the Journal of the American Medical Association identified ED as an early warning sign for future cardiovascular disease.

Dr John Mulhall, director of the sexual medicine research laboratory at Cornell Medical Centre, said: “ED is not just a quality of life issue. Physicians should see it as an opportunity to identify underlying issues, such as coronary angina. ED can predate this by three to five years.

“ED sufferers typically experience a one to two year delay in diagnosis – and the number one reason behind this is embarrassment.”

GPs should screen patients for ED risk factors, King says, and on the basis of this, initiate a discussion on sexual function.

“Have an idea of the profile of a man at risk of ED. Common risk factors include age,
cardiovascular disease, smoker, drinker, diabetic, nerve damage, patients taking a lot of meds,
and depression.

“Then make a statement that shows the relevance of your inquiry into sexual function. Ask an open question that forces past a yes or no.”

Commenting on the study findings, Dr K Radhakrishnan, head of the Urology department at Sheikh Khalifa Bin Zayed Hospital, said he suspected undiagnosed ED may be even more widespread than the figures suggest, pointing to the impact of diabetes on ED risk.
Studies have shown that diabetes sufferers are four times more likely to suffer from ED, and that young, insulin-dependent diabetics have an 11-fold risk of developing the condition.

Radhakrishnan hopes the findings will encourage GPs to take a more proactive approach.

“Family doctors must be more direct, as they are the first point of contact for patients who need a referral.
“Even if patients are being treated for a urinary problem, I ask directly about their sexual function.”

When diagnosed early, minimal ED is far easier to treat as the psychological impact, such as stress and depression, is less established, Mulhall added.

“The majority of ED can be treated at a primary care level. The earlier you diagnose, the easier treatment is.”

Mulhall recommends PD5 inhibitors as a front-line treatment for ED, citing a recent study that showed 76% of men with ED treated with sildenafil citrate (100mg) achieved grade 4
erections, in accordance with the QEQ scale.

However, if after four repeat treatments PD5 use is still not effective, patients should be referred to a specialist, he adds.

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