Followup and Therapeutic Probe

Discussions of follow-up most vividly illustrate the importance of integrating sex therapy and pharmacotherapy. Urologists, Barada and Hatzichristou improved sildenafil nonresponders by emphasizing patient education (e.g., food/alcohol effect), repeat dosing, partner involvement, and follow-up (52,53). Patient education about the proper use of sildenafil was crucial to treatment effectiveness. Physicians can increase their success by scheduling follow-up, the first day they prescribe. As with any therapy, follow-up is essential to ensure an optimal treatment outcome. Initial failures examined at follow-up reveal critical information. The pharmaceutical acts as a therapeutic probe, illuminating the causes of failure or nonresponse (2,15,20). Retaking a quick current sexual history provides a convenient model for managing follow-up. Other components of the follow-up visit include monitoring side effects, assessing success, and considering whether an alteration in dose or treatment is needed. Future comparator trials will help determine which drug works best, for which person(s), under which context. Until then, physicians will likely trust their own judgment and experience. However, physicians must provide ongoing education to patients and their partners, as well as involving them in treatment decisions whenever possible. A continuing dialogue with patients is critical to facilitate success and prevent relapse. The numerous psychosocial issues previously discussed may evoke noncompliance. These are important issues in differentiating treatment nonresponders from "biochemical failures," in order to enhance success rates. Early failures can be reframed into learning experiences and eventual success.

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