Gastroenterologists do not routinely discuss sexual dysfunction with patients who have gastrointestinal (GI) disorders, despite patients’ frequent experience with sexual dysfunction, according to study findings published in Digestive and Liver Disease.
Researchers conducted a national, cross-sectional, online survey of 714 members of the Italian Society of Gastroenterology and Digestive Endoscopy. The survey consisted of 29 questions, answered anonymously by 426 of the 714 (59.7% response rate) gastroenterologists and residents.
Over 70% of the gastroenterologists or residents never or rarely questioned their patients about sexual dysfunction. Experienced gastroenterologists were more likely to question their patients about sexual dysfunction compared with residents (38.5% vs 21.3%; P =.001). Residents more often did not correlate sexual dysfunction with prescribed GI treatments compared with experienced GI specialists (47.8% vs 32.5%; P =.007).
While only 4% of patients mentioned sexual dysfunction during GI visits, men with GI or liver problems most frequently reported erectile dysfunction (75%) and loss of libido (44%), while women most frequently reported dyspareunia (66%), low libido (28%), or arousal disorders (13%). Most patients with sexual dysfunctions had irritable bowel syndrome (26%), chronic liver disease (28%), or inflammatory bowel disease (37%).
Approximately 51% of respondents believed that sexual dysfunctions correlated with use of nonspecified, non-GI-related drugs. Residents more likely attributed sexual dysfunction to other non-GI-related drug regimens compared to experienced practitioners (57.1% vs 44.7%, P =.043).
Some practitioners believed that prokinetics (14.5%) and proton pump inhibitors (18%) contributed to sexual dysfunction in patients with GI problems. More experienced gastroenterologists compared with residents believed that proton pump inhibitors (5.8% vs 0%, P =.018) and prokinetics (19.8% vs 9.5%, P =.028) might contribute to sexual dysfunction.
Even after a patient complained of sexual dysfunction, 75% of the providers reported that they never altered the therapy regimen (85.7% residents vs 64.2% experienced gastroenterologists; P <.01).
Most providers (90%) reported never prescribing phosphodiesterase-5 inhibitors (PDE5i) for the treatment of sexual dysfunction, preferring instead to refer their patients to andrologists (59%) or gynecologists (70%).
Providers reported that lack of knowledge (80%), lack of experience (58%), lack of time (44%), or embarrassment (30%) were barriers to treating patients with GI problems complaining of sexual dysfunctions. Those 80% quoting lack of knowledge of this realm felt that taking courses about sexual dysfunction would be beneficial.
In contrast to their daily practice, around 70% of gastroenterologists believed that all practitioners regardless of subspecialty should be capable of treating sexual dysfunction, and 54% believed that it was their responsibility to discuss these issues with their patients.
“Our data suggest that there is a gap between gastroenterologists’ attitudes and their daily practices regarding [sexual dysfunction],” the study authors wrote. ”Most gastroenterologists agreed with the importance of discussing sexual issues with their patients, but they did not routinely address it. Previous studies have found that most health care providers do not routinely ask patients about sexual problems. There is no doubt that although sexuality impacts on the quality of life (QOL) and represents a fundamental part of medical history, it is often a neglected issue in current clinical practice, including the discipline of gastroenterology.”
Study limitations included use of a nonvalidated questionnaire and potential self-reporting bias when practitioners answered the questions despite anonymity.
Romano L, Zagari RM, Arcaniolo D, et al. Sexual dysfunction in gastroenterological patients: Do gastroenterologists care enough? A nationwide survey from the Italian Society of Gastroenterology (SIGE). Dig Liver Dis. Published online June 14, 2022. doi:10.1016/j.dld.2022.05.016