In the second part of the questionnaire a list of potential sexual problems was presented. The patients were asked to indicate whether they suffered never, seldom, sometimes, often, or always from 1 or more of these problems.
The physician questionnaire, which was piloted in cooperation with 3 family physicians, focused on the frequency of sexual problems in male patients, the treatment of sexual problems in family practice, and the reasons for not talking about sexual problems with the patient.
Data were analyzed using SAS software, version 8 for Windows (SAS Institute; Cary, NC). To test for differences, we used the chi-square test, as appropriate. Correlations among ordinal variables were determined by the Spearman rank correlation.15 The units of analysis were the patient and the physician, respectively. For comparison of the patients’ and their physicians’ statements, the unit of analysis was the practice. Since not all patients answered all items of the questionnaire, we report the denominator where relevant.
Results
Physicians and Patients
Of the 46 family practices approached, 20 (43%), all single handed, gave approval to interview patients in their surgery. Seventeen of these practices were located in a major city, and 3 were in a small town. Nearly all (19/20) answered the physician questionnaire. The participating physicians were, on average, aged 49 years (range=36-61 years). When asked why they did not want to take part in the study, physicians most often said they had only a small number of patients with sexual problems in their practice (6/26) or their patients would not consent to a study dealing with sexuality (8/26). Only 21% of the women physicians addressed took part in the study, compared with 53% of the men.
A total of 307 men (84%) returned the patient questionnaire. Lack of time, feeling too sick, and unwillingness were the reasons most often given by the 57 patients who refused to participate. Demographic characteristics are shown in Table 1. The age distribution is compared with the representative ADT (Accounting Data Record) Panel of the Central Institute of Ambulatory Health Care in Germany (Zentralinstitut für die kassenärztliche Versorgung).16,17
More than 90% of the participating men (279/307) had been consulting their particular physician for more than 1 year. According to their own assessment, 245 patients had informed their physicians about their personal, family, and social background.
Frequency of Sexual Problems
More than 90% of the male patients (251/270) reported having 1 sexual problem at least seldom. Figure 1 illustrates the frequency of sexual problems. These results were not influenced by the patients’ marital status.
Low sexual desire (73%) and premature ejaculation (66%) were dominant problems. More than one third of the respondents suffered at least sometimes from these problems Figure 2. Approximately 5% to 6% of the men reported fear of failure and erectile dysfunction as often or permanent problems. Thirty-seven men (12%) did not answer any of the questionnaire items that referred to sexual problems. These men did not differ in marital status from those who answered these items; however, on average the 37 men were older than the remainder (55 years vs 44 years). Even if we make the (rather unlikely) assumption that all patients who did not answer the sex-related items represent men without any sexual problems, more than 80% of the sample (251/307) suffered at least occasionally from a reported sexual problem. Low sexual desire and erectile problems were weakly or moderately associated with age (rho=0.18; P=.0049 and rho=0.38; P=.0001, respectively).
Half of the patients who had sexual concerns (107/201) considered occupational stress to be a cause of their problems. Pressure resulting from expectations of self (28%), difficulties in relationships (19%), and comorbid diseases (13%) were also considered common causes of their sexual dysfunction. Less common causes included medicines (9%), inhibitions resulting from strict sexual education (8%), pressure resulting from expectations of others (8%), and involuntary childlessness (3%).
As a consequence of their sexual difficulties, 46 of 257 (18%) experienced depression and depression-like symptoms, 36 (14%) sleeplessness, and 35 (14%) difficulties in their relationships. Patients’ satisfaction with their sexual lives was moderately correlated with the frequency of their sexual problems (rho = -0.33; P <.001). Patients who reported suffering sexual problems never or seldom reported satisfaction scores of 7.5 or 7.6, respectively. Patients reporting sexual problems often or always were less satisfied Figure 3. Sexual-life satisfaction and age were not correlated (rho = -0.05; P=.41)
Patients’ Expectations
Most patients considered it important to talk with their family physicians about their sexual concerns (84%). Almost half of the respondents (133/295) preferred that their physician initiate any discussions about sexuality. These expectations were not influenced by patient age (data not shown). More than two thirds of the respondents would have liked their physicians to signal his or her open-mindedness by directly addressing sexual topics during the consultation.