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Taking Sexual History Should be Routine in All Patients

      To the Editor:
      In their article entitled “The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease,”
      • Nehra A.
      • Jackson G.
      • Miner M.
      • et al.
      The Princeton III Consensus Recommendations for the management of erectile dysfunction and cardiovascular disease.
      the authors emphasize sexual inquiry of all men. Erectile dysfunction has emerged as a sentinel marker of cardiovascular disease.
      • Salonia A.
      • Castagna G.
      • Saccà A.
      • et al.
      Is erectile dysfunction a reliable proxy of general male health status? the case for the International Index of Erectile Function-Erectile Function Domain.
      However, the dearth of high-quality controlled studies hampers the development of sexual history-taking curricula for medical students and residents.
      • Coverdale J.H.
      • Balon R.
      • Roberts L.W.
      Teaching sexual history-taking: a systematic review of educational programs.
      Only 35% of primary care physicians report that they often (75% of the time) or always obtain a sexual history.
      • McCance K.L.
      • Moser Jr., R.
      • Smith K.R.
      A survey of physicians' knowledge and application of AIDS prevention capabilities.
      We recently treated an 89-year-old man with multiple comorbidities, including hypertension, coronary artery disease, and myelodysplastic syndrome, who had been admitted for evaluation of abdominal pain and melena. Computed tomography of the abdomen revealed an intriguing 5.3-cm cystic lesion in the pelvis (Figure, A). Coronal images revealed that the “cyst” was connected to a penile prosthesis (Figure, B). Had a sexual history been taken, we would have been aware of the possibility of a penile prosthesis reservoir in the patient's abdomen.
      Figure thumbnail gr1
      FigureA, Transverse computed tomographic (CT) scan of the abdomen reveals a 5.3-cm cystic lesion (arrow). B, Coronal CT scan reveals a penile prosthesis (lower arrows) and abdominal reservoir (upper arrow).
      Physicians are often reluctant to inquire about sexual health issues because of embarrassment, feeling ill-prepared, sexual history not relevant to the current problem, and time constraints. Routine assessment of sexual health would provide opportunities to recognize and treat sexually transmitted diseases and to initiate preventive care including counseling about sexual risk taking and in addition would provide insight about the status of cardiovascular health.

      References

        • Nehra A.
        • Jackson G.
        • Miner M.
        • et al.
        The Princeton III Consensus Recommendations for the management of erectile dysfunction and cardiovascular disease.
        Mayo Clin Proc. 2012; 87: 766-778
        • Salonia A.
        • Castagna G.
        • Saccà A.
        • et al.
        Is erectile dysfunction a reliable proxy of general male health status? the case for the International Index of Erectile Function-Erectile Function Domain.
        J Sex Med. 2012; 9: 2708-2715
        • Coverdale J.H.
        • Balon R.
        • Roberts L.W.
        Teaching sexual history-taking: a systematic review of educational programs.
        Acad Med. 2011; 86: 1590-1595
        • McCance K.L.
        • Moser Jr., R.
        • Smith K.R.
        A survey of physicians' knowledge and application of AIDS prevention capabilities.
        Am J Prev Med. 1991; 7: 141-145

      Linked Article

      • The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease
        Mayo Clinic ProceedingsVol. 87Issue 8
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          The Princeton Consensus (Expert Panel) Conference is a multispecialty collaborative tradition dedicated to optimizing sexual function and preserving cardiovascular health. The third Princeton Consensus met November 8 to 10, 2010, and had 2 primary objectives. The first objective focused on the evaluation and management of cardiovascular risk in men with erectile dysfunction (ED) and no known cardiovascular disease (CVD), with particular emphasis on identification of men with ED who may require additional cardiologic work-up.
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