Primary Patient and Partner Intimacy Discussion

[Rhonda Fine PhD, ARNP]

On another discussion Molly expresses disappointment in information provided in regards to intimacy. In regards to the period between diagnosis and treatment:

1) What would satisfy you as a patient or partner? What do you expect?
2) What would have been the most appropriate resource for you?

[Kathy Meade]

I was told in a conference call by someone who was on the original committee that sexual wellbeing was meant to be part of the report. I have not read the entire report though.

Isn't the goal of treatment QOL. Isn't the idea to bring the patient back to normal functional after treatment? Patients get physical therapy. Is this any different?

Grassley pushed legislation several years ago that stopped coverage under Medicare for anything other than a penile prosthesis because medications were recreational. Tricare pays for 6 pills per month. Insurance companies are all different with some no paying at all.

[Rhonda Fine PhD, ARNP]

Given the cost of these medications and treatments, are we being told 'Sexual Pleasure" is only for those who can afford it?
What other treatments has the government allowed the insurance companies to deny as it relates to our sexual quality of life?

[Kathy Meade]

Nebraska wants to stop paying for any ED treatment under their Medicaid program. If anyone is from Nebraska now is the time to speak out.

Poor Nebraskans seeking treatment for erectile dysfunction may soon be turned away by state government.

State officials are proposing state Medicaid rules be changed so that the insurance program does not pay for penile implants.

State Medicaid director Vivianne Chaumont said the change is consistent with a federal rule, approved in 2006, that barred the federal government from spending Medicaid dollars on erectile dysfunction drugs including Viagra. Nebraska followed suit a few months later and changed its rules to keep state Medicaid money from being spent on the drugs

also

“The decision was made not to cover the drugs, so it’s ... a good idea to have particular procedures for prosthesis not covered as well,” Chaumont said.

Medicaid is meant to pay for the medical necessities of needy people and “sex is not medically necessary,” she said.

To read the entire article:

http://tinyurl.com/3j9wcy

[Arnon Krongrad, MD]

"Sex is not medically necessary." Climactic duo Viviane Chaumont and Gov Dave Heineman of Nebraska are all smiles.

Kathy, why not invite them to join us?

[Rhonda Fine PhD, ARNP]

Sometimes a picture is worth a thousand words.

[Rhonda Fine PhD, ARNP]

It is difficult to believe in a world driven by men, sexual health is not a priority.

[Shai]

Explosive mixure of "Political Healthcare"! This is also a risky path. What's next for the Great State of Nebraska? Produce babies in china and deny maternal benefits becuase it is not medically neccesary, financially cost effective, or POLITICALLY wanted for the Medicaid program to pay poor people to deliver babies in Nebraska?

[Mike]

I don't disagree with you. But that wasn't the question you asked. :O)

The determination of our society as a whole to have appropriate healthcare services available, however, is also highly dependent on the willingness of the professional medical community to partner with the patient community to advocate for appropriate coverage. My (fairly extensive) experience as an advocate has tended to teach me that professional physician advocacy services are very slanted toward their financial rewards. I'm not surprised by this, but ... "wanting" to treat the whole patient and making sure you can would appear to have got divorced somewhere!

[Rhonda Fine PhD, ARNP]

Medicine is exploring the possibility that sexual problems can be treated through medications and surgical procedures.
Psychological research and therapies have increased dramatically in the last decade.
Physicians and licensed sex therapists are beginning to co-partner in an attempt to assist patients with these very personal issues.
However our society needs to insist that sexual difficulties are not different than any other diagnosis.
Personally, I cannot pinpoint where physicians agreed with the notion that sex is not medically or psychologically important enough to become funded.

[Lenny Hirsch]

I do not go along with the words sexual pleasure. May be it is different in your part of the world, but here in Israel many look upon the ability to preform in bed as a sign of his masculinity. Call it a status symbol.
I receive an average of 20 calls a week from men or their parnters seeking help, advice or support. Most before primary treatment, as well as those with problems after the primary treatment. A lot of the problems have sexual connections. I always warn them that life after treatment is not going to be the same, especially the ED question. I try to get them to take their time before deciding what route to take and which specialist will be doing the treatment.
If we get the doctors to realize that to many of the patients, their self image is of primary importance, then we might be getting some where

[Arnon Krongrad, MD]

Lenny, I often hear "Barbadian men" or "Latin men" don't like prostate exam or don't want erectile dysfunction. Often it seems that the emphasis on regional behavior is meant to set up contrast with other regions. I don't know why. As far as I can tell Cuban, Irish, Italian, Nigerian and all other men behave like the Israeli men you describe.

[Molly]

I agree with everything that has been expressed here and I know my friend's experience was that he was certainly not well informed about the impact that undergoing surgery, albeit 'nerve sparing', may have on erectile function. It appeared to be a simple case of, if one opts for nerve sparing then one has a very good chance of being ok in that department. What they failed to explain was that there are many situations when nerve sparing is not an option, location of the cancer, skill of the surgeon etc etc. There simply was no discussion and as someone mentioned before, it appears if you don't ask the right questions, you simply do not get the answers. I do wonder if a female Urologist may take a different approach? Do some male Urologists feel uncomfortable discussing these issues with other males???