A 78-year-old man comes to the office for a regularly scheduled review of his chronic medical problems. The patient has hypertension, coronary artery disease, and type 2 diabetes mellitus, for which he takes metformin, atorvastatin, lisinopril, and nitroglycerin as needed for chest pain. He takes his medications as prescribed and follows diet and exercise instructions. During the discussion, he hesitates, laughs nervously, and says, "I can't get an erection anymore, and my wife says I have to ask you about getting the 'blue pill.'" Which of the following is the most appropriate response to this patient's concern?

Question

A 78-year-old man comes to the office for a regularly scheduled review of his chronic medical problems.  The patient has hypertension, coronary artery disease, and type 2 diabetes mellitus, for which he takes metformin, atorvastatin, lisinopril, and nitroglycerin as needed for chest pain.  He takes his medications as prescribed and follows diet and exercise instructions.  During the discussion, he hesitates, laughs nervously, and says, "I can't get an erection anymore, and my wife says I have to ask you about getting the 'blue pill.'"  Which of the following is the most appropriate response to this patient's concern?

Quizplus · Accepted Answer

11ec160b_35fc_21cc_9249_e3167fed42f1_MD0001_00 Sexual dysfunction is common in older individuals due to comorbid conditions, medication effects, and in women, menopausal changes. This patient is experiencing difficulty with sexual intercourse, and his hesitation in discussing it suggests that he feels awkward in bringing up the subject. In counseling a patient on a potentially sensitive subject such as sexuality, the first objective is making the patient feel comfortable. The clinician should discuss the topic objectively, as with any other medical topic, and avoid giving the impression that the subject of sex is "dirty" or inappropriate. It is generally best to use the same terms the patient uses for bodily functions but otherwise avoid euphemisms. In this particular case, the clinician should begin the conversation by reassuring the patient that sexual dysfunction is common and is a perfectly appropriate subject of discussion between a patient and a physician. (Choice A) The patient already appears to feel nervous discussing the subject of sexuality. This statement conveys empathy but reiterates and draws attention to his anxiety and may reinforce his feelings of awkwardness. (Choices B and E) The patient takes a medication (ie, nitrates) that makes phosphodiesterase inhibitors (eg, sildenafil, sometimes referred to colloquially as "the blue pill") contraindicated. Although the use of phosphodiesterase inhibitors is often complicated in patients with cardiovascular disease, age itself is not a contraindication. (Choice C) Patients are unlikely to bring up a sensitive subject, such as sexuality, if they do not consider it important. This statement may make the patient feel even more uncomfortable in having to justify raising the concern. Educational objective: Sexual dysfunction is common in older individuals due to comorbid conditions, medication effects, and in women, menopausal changes. When counseling patients on sexuality, the clinician should attempt to make them feel comfortable and reassure them that sexual dysfunction is common and is an appropriate subject of discussion between a patient and a physician.

A 78-Year-Old Man Comes to the Office for a Regularly