A word on erectile dysfunction

It can be tough but rewarding to start talking with patients about ED, writes Brad Butt

As pharmacists we all know about erectile dysfunction, its etiology, physiology and management options.

What perhaps we don’t do so well is help our patients that come in with their ED script, or those that come in with risk factors, possibly symptoms, but that don’t know what to ask or how to start that conversation.

And believe me when I say it, they don’t know how to broach the topic with their GP either; perhaps in fact patients find even more difficult to talk with their GP with fears about possible stigma, a percieved loss of manhood, time constraints and the fear of being fobbed off because their blood pressure, cholesterol or diabetic control is more important right now.

Yes, I may generalise and this is not all patients’ experience, however it is the experience of many and it is my motivation for making the gently enquiry.

Yes, as pharmacists we do care and yes we are interested; whats more we might be able to help and not just by breaking the ice and listening but by writing a note to the GP or even suggesting something that might be a more effective option than what is presently being used – good old integrated primary healthcare.

Consider your male type 2 diabetic patient 40-70 years old. When do you think this patient was last asked about erectile health? Nocturnal erections? Erection strength even? He is more likely to have discussed his HbA1c and blood pressure than issues pertaining to his erectile health beacuse its easier. 

Lets not forget why it is important to acknowledge diabetics are more likely to have issues pertaining to their erectile health – its the same reason diabetics are more likely to have issues with their eyes, kidneys, periperhal circulation, touch perception and so on; put simply microvascular damage. 

Interestingly but perhaps not surprisingly we tend to find maintence of erectile function is an incentive to optimise a diabetic regimen; be it compliance with medications, compliance with monitoring BGLs and/or compliance to a diet and exercise regimen. 

The truth may still be that this patient needs some form of oral PDE5i, intracavernosal injection or other assistance with their erection but at least now they know that you and your pharmacy care.

In the two minutes post conversation with the patient, take the time to complete the raft of possible 6cpa initatives (from CIs to DMC) and be sure to jot down some brief notes for the GP, to make them aware that the conversation has been had, giving them a summary as to what was asked and the respective responses.

Inevitably the GP must make the call on what management strategy is most appropriate, however it is at least now on their radar and the patient knowing that you’ve started the conversation is more likely and comfortable to continue it. 

This rationale holds true for any male that you see taking medications for simple issues such as hypertension or cholesterol through to the more complex issues such as MS, Parkinson’s disease, motor neurone disease, and even men with antidepressants, antianxiolitics and the likes for their mental health; these medications are too often overlooked and the conversation never had; compounding what may already be a desperate situation in their life at that time (noting relationship breakdown, stress and anxiety).

The conversation need not be profound or even terribly deep; it would be fair to say we’re not all comfortable to get into the nitty gritty of erectile dysfunction, however as is so often the case in community pharmacy it’s about those kind and caring words said in passing, showing empathy and that genuine desire to help. 

And for the gentleman taking the sildenafil, don’t be shy in asking the perceived hard question: ‘how do you find this works for you because there might be better options now available?’ You, and perhaps more so the patient, may be ever so grateful you did.

Brad Butt is a passionate community pharmacist with a strong clinical background who takes pride in supporting the health of his patients and the wider community; special interests include Men’s Health, childhood and maternal health, palliative care and the treatment and management of blood cancers.

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