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Biomedical subjects

Richard Sadovsky

Publications and source records attributed to Richard Sadovsky.

16 recordsLinked to original sources
PubMed2006

Sexual health inquiry and support is a primary care priority.

The World Health Organization defines sexual health as "a state of physical, emotional, mental and sexual well-being related to sexuality." This broad definition goes beyond simply inquiring about sexual dysfunction and ideally fits the model of patient-centered primary care. As we observe that sexual health and physical health are often closely related, discussions about sexual activity can be very revealing. Sexual intimacy appears positively related to loving relationship satisfaction and stability. Sexual problems have a clear negative impact on both the quality of life and emotional state regardless of age. Learning about specific sexual dysfunctions among men can reveal a variety of as-yet-undiagnosed comorbid pathologic conditions such as: (i) depression and other emotional illnesses; (ii) psychosocial stress; (iii) actual cardiovascular disease as well as related risk factors such as hypertension, diabetes, and/or hyperlipidemia; (iv) hyperprolactinemia; and (v) low serum testosterone. Specific sexual dysfunctions among women can reveal pathologic conditions such as: (i) depression and other adverse imitational and psychosocial conditions; (ii) low serum estrogen or testosterone; and/or (iii) vaginal or pelvic disorders. A discussion about sexual health can be accomplished efficiently in a primary care office with the inquiring clinician having the option to deal with any sexual problems and dysfunctions directly, or to refer the patient to an appropriate specialized care source.

Female↗
PubMed2006

Sexual problems among a specific population of minority women aged 40-80 years attending a primary care practice.

INTRODUCTION: Clinicians are embarrassed about discussing sex with patients and do not know how to ask about sexual problems in a way that will optimize honest and open responses. Learning about inquiry responses and the prevalence of sexual problems among specific groups of women, including minority women, can help identify appropriate inquiry and management pathways. AIM: To better understand useful inquiry techniques as well as to describe the prevalence of sexual problems among a specific group of minority women aged 40-80 years. MAIN OUTCOME MEASURES: Responses to two styles of sexual problem inquiry, direct vs. ubiquity, were compared among sexually active subjects. Prevalence of sexual problems and interest in discussing problems with personal clinician were determined. METHODS: Minority women aged 40-80 years receiving care at one of two Family Health Centers in Brooklyn, New York who could speak English met inclusion criteria. A cross-sectional survey of 212 subjects, the majority being Afro-Caribbean, identified those who were sexually active and then randomly asked about sexual problems using one of two inquiry types: (i) a direct question, such as "Do you have a problem during sex," or (ii) a ubiquity-style question, such as "Many women with diabetes have sexual problems, how about you?" Sexual problems were characterized by recognized phases of female sexual activity. Interest in discussing sexual problems with a personal clinician was determined. RESULTS: Of the 212 women surveyed, 108 (50.9%) were sexually active with 37 (34.3%) of these women responding "yes" when asked about sexual problems using one of the two inquiry techniques. Stratified analysis by age group showed significantly higher reporting of sexual problems when a ubiquity-style inquiry was used among older women aged 61-80 years (P = 0.028) but not among younger ones. The prevalence of sexual problems was 14.8% reporting pain, 12.0% lack of interest, 9.2% lack of excitation, 5.5% lack of orgasm, and 6.5%"other." Forty-three percent of women with problems said they would like to discuss their problem(s) with their clinician. CONCLUSIONS: In a specific minority group of women aged 40 years and older, especially those over age 60 years, ubiquity-style inquiries may encourage more open and honest responses about sexual problems. The most common sexual problem among this group of women was pain. There is willingness and even interest in talking with clinicians about sexual issues. Recognition of sexual problem prevalences helps clarify the high number of women who could be potentially helped with current and future pharmacologic and psychosocial treatments.

Adult↗
PubMed2005

Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference).

Recent studies have highlighted the relation between erectile dysfunction (ED) and cardiovascular disease. In particular, the role of endothelial dysfunction and nitric oxide in ED and atherosclerotic disease has been elucidated. Given the large number of men receiving medical treatment for ED, concerns regarding the risk for sexual activity triggering acute cardiovascular events and potential risks of adverse or unanticipated drug interactions need to be addressed. A risk stratification algorithm was developed by the First Princeton Consensus Panel to evaluate the degree of cardiovascular risk associated with sexual activity for men with varying degrees of cardiovascular disease. Patients were assigned to 3 categories: low, intermediate (including those requiring further evaluation), and high risk. This consensus study from the Second Princeton Consensus Conference corroborates and clarifies the algorithm and emphasizes the importance of risk factor evaluation and management for all patients with ED. The panel reviewed recent safety and drug interaction data for 3 phosphodiesterase (PDE)-5 inhibitors (sildenafil, tadalafil, vardenafil), with emphasis on the safety of these agents in men with ED and concomitant cardiovascular disease. Increasing evidence supports the role of lifestyle intervention in ED, specifically weight loss and increased physical activity, particularly in patients with ED and concomitant cardiovascular disease. Special management recommendations for patients taking PDE-5 inhibitors who present at the emergency department and other emergency medical situations are described. Finally, further research on the role of PDE-5 inhibition in treating patients with other medical or cardiovascular disorders is recommended.

Cardiovascular Diseases↗
PubMed2005

Sexual dysfunction and cardiac risk (the Second Princeton Consensus Conference).

Recent studies have highlighted the relation between erectile dysfunction (ED) and cardiovascular disease. In particular, the role of endothelial dysfunction and nitric oxide in ED and atherosclerotic disease has been elucidated. Given the large number of men receiving medical treatment for ED, concerns regarding the risk for sexual activity triggering acute cardiovascular events and potential risks of adverse or unanticipated drug interactions need to be addressed. A risk stratification algorithm was developed by the First Princeton Consensus Panel to evaluate the degree of cardiovascular risk associated with sexual activity for men with varying degrees of cardiovascular disease. Patients were assigned to 3 categories: low, intermediate (including those requiring further evaluation), and high risk. This consensus study from the Second Princeton Consensus Conference corroborates and clarifies the algorithm and emphasizes the importance of risk factor evaluation and management for all patients with ED. The panel reviewed recent safety and drug interaction data for 3 phosphodiesterase (PDE)-5 inhibitors (sildenafil, tadalafil, vardenafil), with emphasis on the safety of these agents in men with ED and concomitant cardiovascular disease. Increasing evidence supports the role of lifestyle intervention in ED, specifically weight loss and increased physical activity, particularly in patients with ED and concomitant cardiovascular disease. Special management recommendations for patients taking PDE-5 inhibitors who present at the emergency department and other emergency medical situations are described. Finally, further research on the role of PDE-5 inhibition in treating patients with other medical or cardiovascular disorders is recommended.

Age Distribution↗
PubMed2005

Identifying migraine in primary care settings.

Migraine disorders are largely unrecognized and untreated, despite the heavy burden they impose on individuals and society. Studies have shown that the symptom severity and disability associated with undiagnosed migraine are as burdensome as those associated with diagnosed migraine. Of those persons with migraine identified in population-based surveys, many were previously unaware that they had migraine. Furthermore, coexisting headache types and comorbid conditions contribute to misdiagnosis among those who consult a physician for headache. Patients who do seek medical attention for headaches usually visit their primary care providers. The purpose of this review is to highlight the distinguishing characteristics of migraine compared with other headache disorders, based on the new International Classification of Headache Disorders. To aid in diagnosis, simple screening tools, such as ID Migraine (Pfizer Inc., New York, NY), are recommended. The clinical interview and headache diary aid in refining the diagnosis or suggesting the need for further evaluation. Improved recognition of migraine in primary care will increase the rate of successful treatment with effective migraine-specific therapies. This will result in improved functionality and decreased pain, and may help prevent disease progression.

Comorbidity↗
PubMed2005

Erectile dysfunction is a signal of risk for cardiovascular disease: a primary care view.

Erectile dysfunction (ED) is a multisystemic disorder with symptoms most commonly caused by vascular insufficiency. Multiple comorbidities occur frequently among men who have ED; thus ED may signal disorders with similar etiologies, including psycho-social problems, endocrine imbalances, neurologic disorders, and particularly cardiovascular risk or frank disease. Evidence is accumulating that vascular ED signals endothelial dysfunction and cardiovascular disease risk. ED may be a strong signal of increased risk of silent myocardial ischemia in men who have uncomplicated type-2 diabetes mellitus and of future symptomatic cardiovascular disease in men who do not have diabetes. ED patients should be evaluated for cardiovascular risk and frank disease because early detection may allow early treatment and decreased morbidity. The best method for evaluating men with ED for cardiovascular risk, and the role of ED as a screening test for increased cardiovascular disease risk need further study.

Cardiovascular Diseases↗
PubMed2005

The efficacy of tadalafil in clinical populations.

OBJECTIVES: To evaluate the efficacy of tadalafil in men with erectile dysfunction (ED) by demographic and ED characteristics, in patients having various comorbid medical conditions, and in patients receiving drug treatment for other medical conditions. METHODS: This is an analysis of 11 double-blind, placebo-controlled trials with 2,102 men with a broad spectrum of ED etiology and various comorbid medical conditions as participants. The variables analyzed in this report included race, age, body mass index (BMI), ED etiology, ED severity, ED duration, smoking, prior sildenafil use, presence of comorbid conditions (diabetes mellitus, hypertension, cardiovascular disease, hyperlipidemia, depression, benign prostatic hyperplasia), and treatment with antihypertensives or antidepressants. Patients were randomly assigned to receive tadalafil 10 mg (N=321), tadalafil 20 mg (N=1,143), or placebo (N=638). The primary efficacy variables included mean changes from baseline in the erectile function (EF) domain score of the International Index of Erectile Function (IIEF) questionnaire, and the mean per-patient percentage of "yes" responses to the Sexual Encounter Profile (SEP) diary question 3 (SEP3--successful intercourse). The Global Assessment Question 1 (GAQ) was evaluated, as was the percentage of men attaining a normal IIEF EF domain score at end point. RESULTS: Patients taking tadalafil 10 mg or 20 mg demonstrated significant improvement (P<0.005) from baseline to end point on the IIEF EF domain score in all subpopulations analyzed compared with patients receiving placebo. The mean-per-patient percentage of "yes" responses to SEP3 increased significantly in all subpopulations taking tadalafil compared with placebo (P<0.05). Tadalafil-treated patients had a significantly greater positive response rate on the GAQ in all subpopulations analyzed compared with placebo-treated patients (P<0.03) except for the tadalafil 10 mg cardiovascular subpopulation (placebo, 46.8%; tadalafil 10 mg, 71.0%; P=0.127). The percentage of positive responses ranged from 72% to 91% for patients on tadalafil 20 mg and from 52% to 94% for tadalafil 10 mg compared with a range of 20% to 47% for placebo-treated patients. CONCLUSIONS: Tadalafil was effective in improving erectile function across a wide spectrum of ED patients including patients with various comorbid conditions.

Adult↗
PubMed2004

Erection quality scale: initial scale development and validation.

OBJECTIVES: The Erection Quality Scale (EQS) is a new, self-report measure for assessing the quality of penile erections. It is intended to complement existing diagnostic and outcome measures (eg, International Index of Erectile Function, Sexual Encounter Profile) in both clinical practice and outcomes research in erectile dysfunction (ED). METHODS: The initial phases of development and psychometric validation of the EQS are described. Specifically, qualitative research in patients and healthy men was used to generate relevant constructs. On the basis of the findings from these phases, and recommendations from an expert panel, seven constructs were selected for inclusion. Multiple items with different formats were drafted to measure each of the key constructs. An iterative process of cognitive testing, item revision, and item reduction was used to identify the 15 most appropriate items and their optimal response scales. This version of the scale was tested in a 200-subject discriminant validity study designed to gather data for a psychometric evaluation. Participants were classified into ED-untreated, ED-treated, and healthy control groups to evaluate the discriminant validity of the measure in men with different levels of erectile function. RESULTS: The study results supported a robust single-factor structure, indicating that the EQS provides an overall index of erection quality. An intraclass correlation coefficient of 0.85 denotes adequate test-retest reliability. Furthermore, the EQS correlated well with existing measures and differentiated patients from the three ED classifications, a preliminary indication of discriminant validity. CONCLUSIONS: The findings presented provide evidence of the scale's potential utility for measuring erection quality in future studies.

Adult↗
PubMed2004

Clinical evaluation and management strategy for sexual dysfunction in men and women.

INTRODUCTION: The optimal approach for identification and evaluation of the sexual problems in men and women in primary care or general medicine practice has not been consensed. AIM: To provide recommendations/guidelines concerning state-of-the-art knowledge for clinical evaluation and management strategies in the evaluation and treatment of sexual dysfunction in men and women, emphasizing evidence-based medicine and a patient-centered framework. METHODS: An International Consultation in collaboration with the major urology and sexual medicine associations assembled over 200 multidisciplinary experts from 60 countries into 17 committees. Committee members established specific objectives and scopes for various male and female sexual medicine topics. The recommendations concerning state-of-the-art knowledge in the respective sexual medicine topic represent the opinion of experts from five continents developed in a process over a 2-year period. Concerning the Clinical Evaluation and Management Strategies Committee, there were 12 experts from five countries. MAIN OUTCOME MEASURE: Expert opinion was based on grading of evidence-based medical literature, widespread internal committee discussion, public presentation and debate. RESULTS: Three concepts underlie sexual medicine management: (i) adoption of a patient-centered framework for evaluation and treatment; (ii) application of the principles of evidence-based medicine in diagnostic and treatment planning; and (iii) use of a unified management approach in men and women. When taken together, these three principles provide a balanced and integrated approach to sexual dysfunction management. Common algorithms for diagnosis and management of men and women with sexual dysfunction, brief sexual symptom checklists, basics in history and physical examination, indications for specialized referral and development of a follow-up strategy are presented. CONCLUSIONS: More research is needed in understanding the role of evidence-based and patient-centered medicine in the clinical evaluation and management strategies of men and women with sexual dysfunction.

Algorithms↗
PubMed2003

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

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.

Journal Article↗
PubMed2002

Evaluation of dysuria in adults.

Dysuria, defined as pain, burning, or discomfort on urination, is more common in women than in men. Although urinary tract infection is the most frequent cause of dysuria, empiric treatment with antibiotics is not always appropriate. Dysuria occurs more often in younger women, probably because of their greater frequency of sexual activity. Older men are more likely to have dysuria because of an increased incidence of prostatic hyperplasia with accompanying inflammation and infection. A comprehensive history and physical examination can often reveal the cause of dysuria. Urinalysis may not be needed in healthier patients who have uncomplicated medical histories and symptoms. In most patients, however, urinalysis can help to determine the presence of infection and confirm a suspected diagnosis. Urine cultures and both urethral and vaginal smears and cultures can help to identify sites of infection and causative agents. Coliform organisms, notably Escherichia coli, are the most common pathogens in urinary tract infection. Dysuria can also be caused by noninfectious inflammation or trauma, neoplasm, calculi, hypoestrogenism, interstitial cystitis, or psychogenic disorders. Although radiography and other forms of imaging are rarely needed, these studies may identify abnormalities in the upper urinary tract when symptoms are more complex.

Adult↗
PubMed2002

Health care clinicians in sexual health medicine: focus on erectile dysfunction.

A consensus guidelines model was developed for managing erectile dysfunction (ED) by urology nurses and other health care clinicians. The model emphasizes identification of ED in all males older than 40, education and counseling as keys to intervention, and inclusion of partners whenever possible. These guidelines are intended to provide a comprehensive care model for ED patients and their partners, which would be optimally cost effective and clinically relevant. If successful, this new model will allow quality sexual health care to be provided to increasing numbers of patients and their partners.

Counseling↗
PubMed2002

The role of the primary care clinician in the management of erectile dysfunction.

Although many medical problems commonly seen in the primary care clinician's office are associated with ED, the majority of men do not discuss sexual difficulties and activities with their clinician. Patients are, however, appreciative of the clinician's willingness to listen and initiate discussions. Often a new level of patient-doctor relationship is thereby reached, which provides for comanagement of sexual and other disorders. The acronym "ALLOW" defines a 5-step proactive management plan for the primary care clinician to follow in order to improve his or her flexibility and sensitivity of response to the patient's ED; at the same time, "ALLOW" helps the clinician to recognize possible limitations in managing sexual health problems. More overall communication has been related to greater patient satisfaction, which in turn results in patients who are more involved in following through on their care, who have increased confidence in their clinician, and who continue to see one physician for their health care needs.

Journal Article↗