Platano Giacomo, Margraf Jürgen, Alder Judith, Bitzer Johannes
Institute of Psychology, Department of Clinical Psychology and Psychotherapy, University of Basel, Basel, Switzerland.
J Sex Med. 2008 Jan;5(1):47-59. doi: 10.1111/j.1743-6109.2007.00628.x. Epub 2007 Oct 23.
General practitioners (GPs) and urologists are the first medical contacts for men with sexual dysfunction. Previous studies have shown that many GPs hesitate to address sexual issues and little is known about the sexological skills of urologists.
To analyze sexual history taking (SHT) by Swiss GPs and urologists, in terms of active exploration, focus, and competence in discussing and treating sexual dysfunction.
A semi-structured interview was developed and used in face-to-face encounters with 25 GPs and 25 urologists.
Content and frequency of interview responses.
Urologists reported a significantly higher frequency of actively asking male patients about sexual dysfunction (22.80% vs. 10.42%, P = 0.01). GPs and urologists avoided actively asking certain patient groups about sexual dysfunction (e.g., "immigrants,""macho men"). GPs reported a significantly lower percentage of male patients who spontaneously address sexual problems (6.35% vs. 18.40%, P < 0.001). Both physician groups emphasized erectile dysfunction in SHT. Eight percent of GPs and 28% of urologists considered their competence in discussing sexual dysfunction as very good. No GP and 20% of urologists considered their competence in treating sexual dysfunction as very good. Urologists reported having significantly greater competence in discussing (P = 0.02) and treating (P < 0.001) sexual dysfunction than the GPs. Competence in discussing correlated positively with competence in treating sexual dysfunction for GPs (P = 0.01) and urologists (P < 0.001). The majority of GPs (92%) and urologists (76%) reported a need for continuing education in sexual issues.
Our results justify establishing guidelines for SHT in Switzerland to better meet the sexual health needs of male patients. Physicians should be encouraged to routinely inquire about sexual issues, overcome their discomfort with the subject, and regard male sexuality as more than erectile function. A clear need exists for relevant continuing education for Swiss GPs and urologists.
全科医生（GP）和泌尿科医生是性功能障碍男性患者的首批医疗接触对象。先前的研究表明，许多全科医生在处理性问题时犹豫不决，而对于泌尿科医生的性学技能了解甚少。
分析瑞士全科医生和泌尿科医生在进行性病史采集（SHT）时，在积极探索、重点关注以及讨论和治疗性功能障碍方面的能力。
设计了一份半结构化访谈，并在与25名全科医生和25名泌尿科医生的面对面交流中使用。
访谈回复的内容和频率。
泌尿科医生报告称，主动询问男性患者性功能障碍问题的频率显著更高（22.80%对10.42%，P = 0.01）。全科医生和泌尿科医生都避免主动询问某些患者群体的性功能障碍问题（例如，“移民”“大男子主义者”）。全科医生报告称，自发提及性问题的男性患者比例显著更低（6.35%对18.40%，P < 0.001）。两个医生群体在性病史采集中都强调勃起功能障碍。8%的全科医生和28%的泌尿科医生认为自己在讨论性功能障碍方面的能力非常好。没有全科医生，20%的泌尿科医生认为自己在治疗性功能障碍方面的能力非常好。泌尿科医生报告称，在讨论（P = 0.02）和治疗（P < 0.001）性功能障碍方面的能力显著高于全科医生。对于全科医生（P = 0.01）和泌尿科医生（P < 0.001）而言，讨论能力与治疗性功能障碍的能力呈正相关。大多数全科医生（92%）和泌尿科医生（76%）报告需要接受性问题方面的继续教育。
我们的结果证明在瑞士制定性病史采集指南是合理的，以便更好地满足男性患者的性健康需求。应鼓励医生常规询问性问题，克服对该主题的不适感，并将男性性功能视为不仅仅是勃起功能。瑞士的全科医生和泌尿科医生显然需要接受相关的继续教育。
