Umgang mit sexuellen Funktionsstörungen in der Rehabilitation kardiovaskulärer Erkrankungen

BACKGROUND AND PURPOSE: Many studies demonstrate a high prevalence of erectile dysfunction (ED) in cardiovascular patients. Findings show that patients often do not talk about their sexual problems. Many patients believe that their physician would not take their problem seriously. However, they wish to be asked by their physician and want to get information. The medical staff also avoids to broach the issue of sexual problems even when they assume an ED. Reasons for an insufficient inquiry are often lack of time or knowledge as well as emotional inhibitions.

METHODS: 51 members of the medical staff of five hospitals for rehabilitation of cardiovascular diseases filled in a standardized, anonymous five-page questionnaire. It consisted of questions regarding sociodemography, estimated prevalence of sexual dysfunction, knowledge, responsibility, impediments for adequate diagnosis and therapy, as well as need for continuing medical education. Likely predictors (age, sex, profession, knowledge, and responsibility) for an active attitude were examined using relative risks.

RESULTS: Of the 51 employees, 54% were men, more than half were physicians. The mean age was 44.3 years. The estimated prevalence of sexual dysfunction was 45.4 +/- 20.3%. Less than half of the medical professionals rated their knowledge concerning therapy motivation (47.9%) and general consultation of cardiovascular patients (38.8%) as at least good (see Figure 1). While more than two thirds felt responsible for motivation to subsequent treatment of sexual dysfunction, less than one quarter motivated the patients actively. Over 50% felt responsible for consultation and information, but only 27% did it actively (see Figure 2). The main impediment for an adequate management of sexual problems was the lack of time (38.3%). However, every fourth also believed that the patient would not accept the diagnosis (29.2%) or a therapy (22.9%). One third of the employees agreed that the own lack of knowledge makes care of sexual problems difficult. On the question what would be helpful to improve the management with sexual concerns, most employees said that education and training (85.7%) would be the most effective method (see Figure 3). The highest need for training can be seen in diagnostics (64.4%; see Figure 4). Almost all professionals believed that a screener would be reasonable. A higher knowledge state was the only significant predictor for an active management of sexual problems (see Table 1).

CONCLUSION: The reported prevalence of sexual dysfunction in cardiac rehabilitation is very high. This requires skills concerning diagnosis and treatment of sexual dysfunction, which are only scarcely present. Furthermore, there are many impediments that are mainly positioned in the health-care system. The skills should be improved by an effort in continuing medical education. Patients with ED often have depression and a reduced quality of life. To improve the quality of life of patients in the cardiovascular rehabilitation, the treatment of ED is a necessary condition. Trials show that a widespread rehabilitation program which includes a sexual education leads to a better sexual activity. The patients' quality of life can only be improved, if the medical staff includes relevant concomitant disorders to cardiovascular disease, like ED, in the treatment program of patients.