Erectile Dysfunction (ED)

Do you experience sexual desire?

Do you want to engage in sexual intercourse?

Are you experiencing intimacy problems with your partner?

Do you have difficulty achieving and maintaining erections?

How often do you achieve an erection?

Do you experience erections during sleep, while dreaming, or in the mornings?

Are your erections firm enough to achieve penetration?

Do you have problems reaching a climax?

Do you have problems ejaculating?

Do you experience anxiety when thinking about intercourse?

Are there times when your ED is worse? If so, in which situations?

Are you experiencing any depression?

Do you feel sad, blue, or “down in the dumps”?

Have you noticed a decreased pleasure in life?

Are you happy with your sexual partner?

Do you have a good relationship with your sexual partner?

When did this problem begin? Was it abrupt or gradual?

How has ED affected your sex life?

Are you or your partner angry about this problem?

Have you ever been diagnosed with diabetes, high blood pressure, or high cholesterol?

Are you experiencing any changes in your appetite, thirst, urinary patterns, or weight?

Do you have any history of disease involving the heart, blood vessels, nerves, or hormones?

Have you ever had urogenital trauma or surgery?

Have you ever been diagnosed with prostate problems?

Do you experience any problems with urinary voiding? Do you experience urgency, frequency, straining, hesitancy, incomplete bladder emptying, or weak urine stream?

Do you smoke or use any tobacco products?

Do you drink alcohol?

Do you use recreational drugs such as marijuana, cocaine, or heroin?

How active are you throughout the day? Do you engage in regular aerobic exercise?

What are your hobbies? Do you routinely ride bicycles, motorcycles, or horses? Do you take regular cycling classes at a gym?

Menopause

How often do you menstruate?

How many days does each period last?

How many days lapse from the start of one period to the start of the next?

Do you experience heavy or light flow?

When was your last menstrual period?

Is there any likelihood that you are currently pregnant?

Have you had a hysterectomy? If so, was one or both ovaries removed? Was the cervix removed? How long ago was the procedure?

Many women who experience hormone fluctuations complain of hot flashes and night sweats. Have you noticed any problems with temperature control?

Have you noticed any waves of heat that begin in your scalp and move across your torso?

Have you experienced any feelings of being hot even when other members of your family are comfortable?

Have you been adjusting the thermostat to a cooler temperature at home, even though others in your household are cool or cold?

Have you been wearing lighter clothing while at home because you are often hot and uncomfortable?

Have you been awakened at night by hot flashes and sweating?

Have you changed the type of covering that you use at night or started kicking off the covers during the night because you are sweating?

Are you sleeping through the night?

Are you experiencing any daytime fatigue due to sleep disruption?

Have you passed urine when you did not intend to, such as when you have coughed, laughed, or sneezed?

Are you experiencing any vaginal dryness or discomfort?

Have you noticed any change in your desire for intercourse?

Are you experiencing intimacy problems with your partner?

Do you have difficulty with vaginal lubrication?

Do you have problems reaching climax?

Do you experience any vaginal bleeding after intercourse?

Do you experience anxiety when thinking about intercourse?

Are you experiencing any depression?

Do you feel sad, blue, or “down in the dumps”?

Have you noticed decreased pleasure in life?

Are you happy with your sexual partner?

Do you have a good relationship with your sexual partner?

When did you first notice sexual dysfunction? Did this problem develop abruptly or gradually?

Describe the emotions you have felt since your problems with sexual function developed. For instance, are you or your partner angry about this problem?

Regardless of the emotions displayed during an interview, it is important to show empathy in communicating with the patient. For example, a comment such as “It must be very difficult to function at work when you are not able to sleep at night” may be effective. It indicates that you have heard what the patient is describing and understand the potential impact on the patient’s life. If the pharmacist does not know what to say, repeating the patient’s own words, verbatim—for example, “You feel lonely and isolated since you moved to this new town”—can be very effective. Try not to discount or minimize anything the patient says, and resist the temptation to say, “Don’t worry, everything will be OK.” A statement like this minimizes the patient’s distress and can make the patient feel alienated. A better response is to convey to the patient that his or her concerns are respected and important.

When a patient presents a problem, there is a natural tendency for the health care provider to immediately jump in to solve or minimize the problem instead of attending to how the patient feels about it. Let’s look at dialogues with two patients; the first shows inappropriate responses by the pharmacist, and the second shows more effective responses.

ED Dialogue 1

Patient (to clerk): Could I talk to the pharmacist?

Clerk: Sure. (yells back to pharmacist) This guy wants to talk to you.

Pharmacist (from the prescription area to the patient, who is 20 feet away): Yeah, what is it?

Patient (motions to the pharmacist to come forward): I need to speak to you.

Pharmacist (rolls eyes and comes down to patient): Yes?

Patient (hands over prescription): I’m a little embarrassed about this.
I feel bad that I even have to use this. Is it really gonna work for me?

Pharmacist: Oh sure…yeah…don’t worry! Lots of guys come in for this. I’ll get it filled for you right away. Don’t you worry. Be glad there is something you can use to help you.

Patient: It’s just that it’s been a while since my wife and I have been intimate, and I hate it that I have to rely on a drug to…to…you know.

Pharmacist: Yeah, I know, but hey, like I said, at least there’s a drug to help you out. So let me go and I’ll get this filled right away.

Patient (sheepishly): OK.

Discussion

This pharmacist does not do anything that is blatantly wrong, but his approach is to quickly address the patient’s concerns and move on. He does not really address those concerns, however. This is probably because the pharmacist is uncomfortable discussing this subject. In addition, the patient is left feeling embarrassed and uncomfortable. By yelling back to the pharmacist, the clerk furthers the patient’s embarrassment and discomfort, and the patient feels even more exposed. Let’s look now at how this might have been handled more appropriately.

ED Dialogue 2

Patient (to clerk): Could I talk to the pharmacist?

Clerk: Sure. (walks back to the pharmacist) The man at the counter would like to talk to you.

Pharmacist (walks to the patient from the dispensing area): Hello, I’m Ken Brown, the pharmacist. How may I help you?

Patient (hands over prescription): I’m a little embarrassed about this. I feel bad that I even have to use this. Is it really gonna work for me?

Pharmacist (looks at the prescription): Let’s go over here where we can talk more privately (motions patient to a quiet area of the store). It can be awkward and uncomfortable to talk about things like this. Sometimes it’s difficult to accept that this is happening and you need medication to be able to do something that used to be very natural to you as a man.

Patient: Yes, I don’t like it at all.

Pharmacist: I see that. This drug has been shown to be very effective in helping men get an erection. Did your doctor rule out any health problems that may be contributing to this?

Patient: Yes, he was very thorough. He just said that sometimes men my age don’t get enough blood flow, so they have problems.

Pharmacist: That’s correct, and it is more common than most men realize. This medicine will help to get the proper blood flow to the penis so you can get an erection when you are aroused.

Patient: I just feel sort of…I don’t know.

Pharmacist: You don’t like needing to depend on a drug to get an erection.

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