Sexual function is widely considered to be of importance in quality of life. This function is frequently altered in patients with coronary artery disease. As mentioned earlier, ED may be among the first manifestations of disease because the erectile function heavily depends on both the arterial system perfusing the penis as well as on the delicate endothelial system within the smooth musculature of the cavernous bodies. Because the arterial system must enlarge considerably in diameter to enable penile tumescence, these vessels may be more sensitive to atherosclerotic occlusion than the coronary circulation or other vasculature. The assessment of erectile status may indeed give clues to clinically silent yet progressive coronary, peripheral or cerebrovascular disease as well as to underdiagnosed hypertension, diabetes, or other endocrine disorders. Patients with multivessel coronary disease may have greater difficulty achieving an erection than those with single-vessel disease. On top of the intrinsic effects of cardiovascular disease, drugs used to treat heart disease such as p-blocking agents and thiazide diuretics have been associated with the development of ED. Omnicef antibiotics
Because of the growing awareness of ED among patients, media and physicians and the changing face of treatment approaches, cardiologists are more frequently consulted by their patients and fellow physicians. Some cardiologists believe that discussions about sexuality fall outside the realm of their responsibility, or they may think that these discussions are embarrassing for patients and themselves. Propecia hair growth. Open and frank discussions about sexuality between physicians and patients are a prerequisite for addressing treatable causes of sexual dysfunction. In a study addressing cardiologist’s discussions on sexuality with patients it was mentioned that a considerable portion of patients would like their cardiologist to take a full sexual history (81% in males) and that they would be comfortable with these discussions. However, the majority of patients believed that they were inadequately informed about sexual functioning. Male patients believed that physicians were comfortable about discussing sexuality but noted that detailed questioning occurred only rarely (table 1).
Physicians should initiate the discussion on ED by being direct, forthright, and nonjudgemental. An example of an introductory question on sexual function could be: ‘Some men may have sexual difficulties after myocardial infarction, bypass surgery or from cardiac medication’. In addition, the more routine use of a sexual function questionnaire for men aged >40 years can be an easy springboard for discussion. impotence drugs. The Sexual Health Inventory for Men (SHIM) is a valid and reliable instrument that takes only a few minutes for the patient to complete (table 2).
Initiatives such as specialised Male Cardiovascular Health Clinics with a multidisciplinary team consisting of a cardiologist, urologist and cardiac sexual advice nurse to help cardiac patients with sexual problems have recently been instituted and have shown very favourable results. Several factors influence sexuality in the elderly, among them the overall health status of both the patient and the partner and use of medications. An important element in cardiac rehabilitation of patients with coronary heart disease is counselling about sexual activity; however, counselling occurs only infrequently. Cardiac rehabilitation programmes are the key to helping cardiac patients to resume their sexual activities. canadian drug store