Making Best Practice, Every Day Practice
Erectile dysfunction (ED) is three to four times more common in men with diabetes, and 20% have the condition at diagnosis. ED is a marker for heart disease, and men themselves value the opportunity to discuss their sexual problems with a health professional. The annual diabetes review offers the opportunity to identify and treat these men. Some practice nurses may find this task daunting, but treatment of ED can help to improve a man’s wellbeing and reduce his cardiovascular risk.
Androgens such as testosterone, male sex hormones produced by the testicles, control the development and maintenance of masculine characteristics. Reduced testosterone levels—known as male hypogonadism—may cause both physical and psychological effects. These effects may be severe enough to compromise a man’s general wellbeing and his sex life in particular. But the decision to replace testosterone is not always straightforward, and patients need careful monitoring before and after starting treatment.
There is conclusive evidence that low testosterone is associated with erectile dysfunction (ED) and that ED is a strong marker for cardiovascular risk. There seems to be a link between testosterone level and mortality, and there are suggestions that testosterone replacement therapy may reduce mortality.
Male hypogonadism—also known as testosterone deficiency syndrome—occurs when the testes no longer produce enough testosterone. Testosterone deficiency may be an important factor in increasing a man’s cardiovascular risk. However, the symptoms are often overlooked in older men, both by primary healthcare professionals and by patients themselves.
The quality of many of our patients’ lives would improve if they had the choice and ability to be sexually intimate. It is relatively common for men who suffer from cardiovascular disease or diabetes to suffer from erectile dysfunction (ED). They often feel too ashamed to initiate sex with their partner, or start a new relationship, because they are unable to gain or maintain an erection. They can become socially isolated and aviod physical contact. As healthcare professionals, we owe this group of patients an opportunity to talk about their sexual problems and to offer them support and treatments. But how do we open up a discussion about sex?
Getting people to act on advice is a continuing challenge for health professionals, particularly in the self-management of chronic conditions. In this article, we explore why men are less likely than women to fully engage with their own health needs and what health professionals can do to help men get better at this. Using the behavioural theory of communication – the Theory of Primitive Concerns – we will look at how different responses to risk – with women typically being risk-averse and men being risk-seeking – mean they respond differently to two alternative styles of clinical instruction based on using ‘power language’ and ‘safety language’. The theory is that we can help men to look after their own health by using language that matches their attitude to risk and presents self-care in a more powerful way.
Erectile dysfunction (ED) is a marker for cardiovascular disease, and it represents an opportunity for the clinician to intervene and reduce the patient’s cardiovascular risk. This article provides guidance on taking a history, investigations and treatments, all timely now that ED has been added to the Quality and Outcomes Framework (QOF) for 2013.
Erectile dysfunction (ED) and vascular disease share the same risk factors and commonly co-exist. The presence of ED in otherwise asymptomatic men is, therefore, often a useful early warning sign of silent vascular disease. This fundamental concept highlights the importance of ‘looking beyond the penis’ in the evaluation of the ED patient, and challenges practice nurses to consider ED and sexual activity as part of their routine evaluation of patients. Once diagnosed, there is a range of effective treatments for ED, and guidance on how to use them safely in patients with cardiovascular disease (CVD).
The arteries that supply the penis are very small and may be more prone to atherosclerosis than larger vessels. This means that the penis may be the first area in a man’s body to suffer from a reduction in blood flow and so signal cardiovascular disease.
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