The Treatment of Sexual Dysfunction: A Nurse-Based Clinic

Richard S. Ferri, PhD, ANP, ACRN, FAAN

Disclosures

June 19, 2006

Editor's Note:
Sexual dysfunction is defined as a persistent impairment of a couple's normal patterns of sexual interest and/or response.[1] Sexual dysfunction is the general term for all male or female sexual problems including desire disorders, orgasmic disorders, rapid/premature or delayed ejaculation, sexual pain disorders, erectile dysfunction, sexual response disorders, and curvature of the penis (Peyronie's disease). However, like many sexual concerns, it is often a complicated clinical and psychosocial condition that frequently is avoided due to patient and clinician embarrassment.

Although healthcare professionals believe sexuality issues are important, they are often not likely to address these issues with patients. Some would argue that many patients needlessly do not receive the appropriate diagnosis and treatments of their condition and that their quality of life is diminished.

At Northwestern Memorial Hospital (NMH) in Chicago, Illinois, Jeff Albaugh, MS, RN-APN, CUCNS, Clinical Nurse Specialist, (see Figure 1) has been instrumental in addressing sexual dysfunction problems with patients in the Sexual Dysfunction Clinic since 1994. Through a collaborative effort with urologists, Jeff and colleagues took on the challenge of diagnosing and treating patients with sexual dysfunction. Here is how Jeff helped make a difference.

Figure 1.

Jeff Albaugh, MS, RN-APN, CUCNS, Clinical Nurse Specialist

Medscape: While the treatment for sexual dysfunction seems fairly common today, at one time it was certainly a taboo subject. Can you please tell us how your clinic came about?

Jeff Albaugh, MS, RN-APN, CUCNS: The Northwestern Memorial Hospital Sexual Dysfunction Clinic began through the collaborative efforts of Dr. Kevin McVary, a urologist and Associate Professor of Medicine at Northwestern University. Feinberg School of Medicine, and myself. At first, the primary focus of my job was working with patients with incontinence. I was then approached by Dr. McVary asking if I would teach patients who had been prescribed intracavernosal penile injections to treat their erectile dysfunction (ED) how to perform self-injections.

As a nurse I always believed that teaching is one of the most crucial roles we play in helping patients incorporate prescribed treatments into their lives.

The teaching sessions were detailed and included written, verbal, and video instruction on penile injections, as well as a demonstration from the nurse of the injection technique using an artificial model. Once these objectives were accomplished, the patient performed a self-administered return injection of an initial test dose of the medication. The patient was monitored for a time after the injection for efficacy and any untoward side effects.

Everyone involved with the clinic, from staff to patients, was very pleased with the program. It was a great opportunity to help patients feel comfortable with a very sensitive and personal issue, while teaching them to use the prescribed treatment in a safe and appropriate manner.

Not long afterward, the urologists and I began to explore other services we could offer. Over time, I came to perform the penile vascular color Doppler studies for patients, titration and management of medications, including all injectable medications, transurethral suppositories, vacuum constriction devices (VCD), and other treatment options for ED and sexual dysfunction.

In my current role, I work closely with an interdisciplinary team to provide comprehensive services. The team includes nurses, physicians, social workers, psychologists, and other healthcare professionals. Some patients are referred for a full evaluation and management of their sexual health problem, while others are simply referred to us to help them incorporate a specific treatment into their life and the life of their partner. If there is a committed partner, we always try to include him or her in the evaluation and management of sexual dysfunction. The treatment options offered through the clinic require intense individual time to work with each patient and his or her partner.

Medscape: What are the advantages (and any disadvantages) of your clinic being a nurse-run clinic?

Jeff Albaugh: Our nurse-run clinic is one in which all care in the clinic is provided by advanced practice nurses and other nursing staff. Nurses are trained to orchestrate and facilitate care for patients and to provide in-depth education. These critical elements are the core of the work done at our clinic. Nurses at the clinic take time with each patient to ensure that they make informed treatment choices and that they completely understand all aspects of care. Sometimes our visits can last as long as 2 hours.

The clinic succeeds because of the win-win relationship of collaboration between the physicians who refer patients and the nurses who run the clinic. The physicians are crucial collaborators in the care of these patients, and the nurses provide comprehensive education, clinical management, and follow-up. These elements are essential to successful treatment of sexual dysfunction.

Medscape: How is the NMH sexual dysfunction clinic funded?

Jeff Albaugh: The clinic is currently part of NMH, and each patient who is seen at the clinic is billed from the hospital through their insurance. The hospital is committed to providing the service to each person who comes to the clinic, and the reimbursement varies greatly, depending on coverage. However, for patients without insurance, we ultimately function within the hospital and provide service to any patient who is referred. As with any service at NMH, uninsured patients who cannot afford services can apply for and potentially receive care at a reduced cost or without charge.

Medscape: How are patients referred to your clinic, and who refers them? Is it a mixed population of both men and women, or just a signal gender focus — and why?

Jeff Albaugh: The clinic is open to any patient who is referred for care. However, the majority of the referrals are currently from urologists, so the majority of patients are men. However, I envision that will change as the hospital continues to explore the options of expanding services and educating the public about sexual dysfunction in men and women and the services our clinic provides. Patients can be referred from any specialist, including urologists, urogynecologists, gynecologists, cardiologists, oncologists, nephrologists, and professionals who provide primary care.

Medscape: How did you become interested in sexual dysfunction and its treatment?

Jeff Albaugh: I have been in nursing for about 25 years and am now in a PhD program in nursing research at the University of Illinois in Chicago. Through my clinical practice and education, I have developed a real passion for helping patients improve their quality of life. I have found over the years that sexual issues and dysfunction are rarely addressed with patients, and that patients are embarrassed to initiate the discussion with healthcare professionals. In my work with these patients, I have found it to be an incredible privilege and honor to help people through these personal problems. Each day, I have the opportunity to help my patients move toward greater quality of life and healing. Each patient is so grateful to finally have someone address these issues, and often that is one of the greatest benefits of my job.

As one patient told me through tear-filled eyes, "You can't know what you have given me and my wife today. . .it is immeasurable." I have personally seen the incredible impact providing this care makes in the patient's life. Nursing is about helping patients move toward healing and a more satisfying life, and the sexual dysfunction clinic offers me the opportunity to do just that. My greatest hope has been for my life to make a difference in the world. Nursing has allowed me to make that difference, one patient at time. I feel so blessed to have the opportunity to really spend time with patients to help them move toward their health goals.

Medscape: How has the advent of multiple pharmacologic options to treat male ED affected the patients and staff of your clinic?

Jeff Albaugh: The advent of the oral agents for ED largely changed the world for us and raised awareness about sexual dysfunction. Patients actually started talking about sexual issues!

The new oral medications offer an excellent option for men, but they do not work for everyone. It is crucial that patients work with a qualified healthcare professional to understand the multifaceted aspects of sexual dysfunction and all the options available for treatment. An expert clinician will help the patient and his or her partner incorporate the treatment option into their love-play to improve quality of life.

Currently, the EROS-CTD (Clitoral Therapy Device) is the only US Food and Drug Administration-approved option for women with sexual dysfunction. We hope that, with some of the clinical trials in progress on various treatments for female sexual dysfunction, women will soon have more options available.

The bottom line is that we need more additional safe and efficacious treatment options. We need science to provide clinical evidence for the best treatment for all forms of sexual dysfunction for both men and women.

Medscape: As the current President of the Society of Urologic Nurses and Associates, can you please explain a little about your association and why our nurse readers may be interested in joining it? Does the organization provide any resources for nurses on sexual dysfunction?

Jeff Albaugh: The Society of Urologic Nurses and Associates and Associates is a nonprofit organization that is dedicated to empowering nurses and the community with knowledge about urologic problems. This goal is met through the publication of Urologic Nursing (a professional, peer-reviewed journal), a newsletter, 2 national conferences each year, and multiple other local and regional educational meetings.

Through SUNA and SUNA's partnership with other organizations, such as the National Association for Continence, Us TOO, and The Simon Foundation, urology healthcare professionals have an opportunity to participate in community awareness programs about urologic issues. Community outreach is another strong component to the work of SUNA. Sometimes this involves a health education program, sometimes a screening event, or passing out pamphlets at a health fair, and at other times it involves providing toiletry products to a women's shelter.

Through SUNA I now have developed professional and personal relationships with other clinicians who are experts in the various areas of urology, whom I can contact at any time to consult about urology issues. SUNA provides fact sheets for patients as well as articles and clinical guidelines for healthcare professionals. I would highly encourage all nurses to seek out and become involved with nursing professional organizations such as SUNA. My involvement in this organization has helped me stay connected to nurses all over the country and even abroad who inspire me to do greater things in my specialty nursing field.

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