Erectile dysfunction: is it really that difficult to talk about? An interpretative phenomenological exploration
Background\ud This thesis explores the disclosure of erectile dysfunction to healthcare professionals by asking men with erectile dysfunction, their partners and healthcare professionals to recall their experiences of such conversations. Erectile dysfunction can be a difficult subject to broach or disclose, and as a result, it is considered that the condition is under reported and therefore under diagnosed. In the light of erectile dysfunction being considered a possible marker of cardiovascular risk this thesis seeks to highlight the issues around disclosing the condition with a view to improving disclosure rates and therefore informing subsequent cardiovascular risk assessment.\ud Literature\ud There is a body of literature which demonstrates that erectile dysfunction is a common issue which is correlated with many physical and mental health conditions. Specifically within populations of men with known cardiovascular disease prevalence rates of erectile dysfunction can be as high as 70%. Literature which explores the experience of having erectile dysfunction and disclosing it to a healthcare professional demonstrates that this is a conversation which is complex and is often avoided by both men with erectile dysfunction and healthcare professionals alike. In light of literature which demonstrates that ED and cardiovascular disease are linked, and that which demonstrates that disclosing ED is difficult there is a gap in the literature which specifically explores the disclosing of ED when it is a known marker of cardiovascular disease risk. \ud Research Process\ud Following a cardiac event, men who identified themselves as having erectile dysfunction, their partners and healthcare professionals to whom a disclosure may be given, were approached and asked to describe their experiences. The study was designed using a phenomenological perspective so as to allow the thoughts and experiences of the participants’ and researcher to be used to provide an illustration of the disclosure of erectile dysfunction, particularly when considered as a precursor and marker of cardiovascular risk. The initial analysis used a thematic approach but this was found to be problematic in relation to the depth of the data that was captured and therefore a second analysis was undertaken, the results of which are presented as the findings of this study. The second analysis of data used a staged approach favoured in interpretative phenomenological analysis (Smith et al. 2009), which facilitated an analysis of the interview transcripts descriptively, interpretatively and linguistically. This latter analysis provided a unique perspective in relation to the topic which is acknowledged as difficult to discuss, and resulted in the linguistic tools which were used by the participants being identified as evidence for the embarrassment; this was identified as one of the themes which emerged from the descriptive analysis.\ud Analysis and Findings \ud Analysis of the interview data with men and their partners identified the themes of: the impact that erectile dysfunction has had on their lives, disclosure (or not) of erectile dysfunction and erectile dysfunction in contemporary society. The interviews with healthcare professionals generated themes which resonated with those from the men as well as focusing on professional issues of ownership in relation to ED disclosure, anxieties in relation to such discussions and experience of receiving disclosures.\ud All of the themes have been extensively written about in relation to other health related issues but they have not been explored explicitly in relation to the disclosure of erectile dysfunction and therefore a unique position of the findings in relation to the existing literature is evidenced within Chapter Nine. The discussion located the findings specifically within existing literature related to embarrassment, stigma and medicalisation. The discussion of the analysed data within the context of the existing literature is then extrapolated to the current clinical environment and changes to clinical practice are suggested by linking the findings to practice. Suggested adaptations to clinical practice focus on improving the confidence of all involved in the disclosure of erectile dysfunction in having such conversations, by increasing the opportunities for them to occur and improving the confidence of all involved in managing such situations.
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