Asking the questions and offering solutions: the ongoing dialogue between the primary care physician and the patient...

Primary care physicians are becoming more involved in inquiry about and management of erectile dysfunction (ED). This relatively new occurrence is appropriate considering that the presence of ED may signal potentially serious medical conditions and that ED is a condition with true morbidity. Addressing sexual issues in the office setting requires a comforting and secure atmosphere in which patients can easily discuss their problems. Because many men are hesitant to approach physicians with their sexual problems, clinicians need to be proactive by asking direct questions, either verbally or in a written history format. The clinician who learns of a patient's ED should acknowledge it as a legitimate problem and either work with the patient on a management plan or refer him to a physician more prepared to successfully manage the condition. Clinicians who choose to treat men with ED can achieve higher success rates by including the partner in the discussions and treatment planning and by offering some basic sex counseling. These efforts require additional learning on the part of the clinician, but the rewards of managing sexual dysfunction include happier and healthier patients and improved patient-partner relationships.