Sexual Problems Common in Gastrointestinal Patients, But Doctors Often Avoid the Topic


VIENNA — Sexual dysfunction in patients with gastrointestinal disorders is undermanaged, with a lack of clinician training, time constraints and discomfort preventing meaningful 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, according to the survey.

“While patients with gastrointestinal disorders often suffer from sexual dysfunction, discussions about this are not common in gastroenterological care,” said Marco Romano, MD, of the University of Campania “Luigi Vanvitelli “, Napoli, Italy.

Romano presented the survey results at this year’s United European Gastroenterology (UEG) 2022 meeting.

The research not only shows a clear need for better awareness, but also a need to build gastroenterologists’ confidence in treating sexual dysfunction with their patients, Romano added.

“Most felt that sexual medicine education and improved communication skills as part of their residency training could be important in order to increase awareness of sexual dysfunction, overcome barriers and improve relationships. care and quality of life for their patients,” said Romano. “This will lead to prompt diagnosis and treatment of any sexual issues.”

Respectfully asking the patient if their gastrointestinal disorder interferes with their intimate relationships “is often seen as a relief to patients who find the gastrointestinal problem and sexual dysfunction to be related,” he added.

The results

The survey was necessary because the question of whether gastroenterologists inquire about their patients’ sexual problems 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 review of the literature, consisted of 29 multiple-choice and open-ended questions.

A total of 426 surveys were returned, including 335 from experienced gastroenterologists and 91 from (less experienced) residents. Of all respondents, 54.7% were male and 45.3% were female.

Even though most gastroenterologists don’t ask their patients about sexual dysfunction, the majority want to learn how to manage the problem, according to the survey. Of the survey respondents, 80% agree that it would be useful for gastroenterologists to take courses dedicated to the problem of sexual dysfunction.

Only 4% of patients report (engage in dialogue) the problem, according to the survey. In women aged 40 to 50, the most frequently reported complaint was dyspareunia (pain during intercourse). Among men, the most common complaints reported were in the over 40 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 disease (37% of cases), chronic liver disease (28%) and irritable bowel syndrome (26%), according to the ‘investigation.

The survey asked whether clinicians believed that the drugs played a role in patients’ sexual dysfunction. Almost 15% of respondents said prokinetic agents were involved and 18% thought proton pump inhibitors affected sexual function. Both classes of drugs are believed to be responsible for sexual disorders.

According to the survey, few gastroenterologists prescribe phosphodiesterase type 5 (PDE5i) inhibitors, for example Viagra, to treat sexual dysfunction. About 90% of respondents said they never prescribe this class of drugs, preferring to refer patients to an andrologist. Among those prescribing PDE5i, significantly fewer residents did so than experienced gastroenterologists (1.1% vs. 8.8%, respectively; P = .01).

Finally, the main reasons why gastroenterologists do not discuss sexual dysfunction are lack of knowledge (80%), lack of experience (58%), time (44%) and embarrassment (30%). ).

Practical experience matters

There were some differences between the respondents in the experienced group and the residents. More men were in the experienced group compared to residents (57.6% versus 44%, respectively); the mean age was 47 versus 29, respectively; and 71% had 5 or more years of experience in the experienced gastroenterologist group, while 78% had 1 to 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 = 0.001) and that more residents than experienced gastroenterologists stated that “the patients did not relate their sexual dysfunction to the prescribed treatment” (47.8% versus 32.5%, respectively; P = 0.007).

The two groups also varied with respect to the role of prescription drugs in sexual dysfunction. Gastroenterologists with more experience than residents rated proton pump inhibitors (5.8% versus 0%, respectively; P = 0.018) or prokinetic (19.8% versus 9.5%, respectively; P = 0.028) may be responsible for some degree of sexual dysfunction.

More residents than experienced physicians felt that other (non-gastroenterological) medications might contribute to sexual dysfunction in their patients (57.1% vs. 44.7%, respectively; P = 0.043).

Romano reported that fewer residents than experienced gastroenterologists referred male patients with sexual dysfunction to an andrologist (often/always: 28.1% versus 44.4%, respectively; P = 0.004). However, more residents than experienced gastroenterologists disagree that discussing sexual dysfunction with patients is only for specialists (andrologists and gynecologists; 83.5% vs. 71.2%, respectively ; P = 0.018).

It’s time to step up a gear

Asma Fikree, BMBCh, MA, MRCP, PhD, from Royal London Hospital, Barts Health NHS Trust, London, UK, moderated the session. The survey highlights that asking patients to talk about sexual dysfunction is an area for improvement for gastroenterologists, she said.

“We could do it in men and ask about erectile dysfunction, but we’re very poor at asking women,” Fikree noted.

The pros and cons of different drugs should be discussed with patients, she said.

Gastroenterologists need to do a better job of determining how drugs can cause sexual dysfunction and interfere with quality of life, and training would be helpful, she added.

“Some patients might not be very bothered by the sexual dysfunction, but others might see it as very important,” Fikree said. “We should consider 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 relationship.

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