Examination of Witnesses (Questions 620-625)
THURSDAY 28 NOVEMBER 2002
DR GEORGE
KINGHORN, DR
PAT MUNDAY,
DR CHRIS
FORD, MS
MARIAN NICHOLSON,
MR GRAHAM
TAYLOR AND
MS JACKIE
ROGERS
620. To come back to the question the Chairman
has raised at intervals, would it help if all services were put
together under one umbrella? Would that make it easier to deal
with this problem rather than it being presented in different
forms?
(Dr Kinghorn) I do not think any of use have any problem
with the concept of services being co-located. The problem is
that virtually every department in the country would need to be
rebuilt under those circumstances and so there is a time problem
and there is a funding problem. I think that what matters before
that decision is made is the partnerships, the collaboration and
the communication has to be in place. If we can make sure that
a person is seen in all of the services that are necessary for
that person within the same day or within a reasonable period
of time, by good communication we can facilitate that particular
care pathway, that is okay. The worry that I have is that we are
arguing for a model which exists in very few places at this present
time and which as yet has not been evaluated. In theory it sounds
correct, I would just like to ensure that we have more information
about it before we all choose that particular path. I know the
Department is looking at that at the moment. We also have to remember
that some of the problems of sexual dysfunction tend to affect
an older age group and one of the problems for younger people
is they might not just see their sisters and brothers but also
their fathers, and that in fact could be an issue which adversely
impacts upon service acceptability.
621. Okay, so you are saying older people may
not want to access that sort of service. I think that is right.
It depends what patients will tell us and Marian was saying before
that one size may not necessarily fit all and we have got to take
advice from our local communities.
(Ms Rogers) Sexual dysfunction therapy is very time
consuming and therefore very expensive. Most therapists will see
a patient for an hour and they will contract with them to see
them over a period of time so it is a very expensive service and
it falls between two areas really. Some sexual health clinics
have taken on therapists but it is almost a luxury and funding
is the issue.
(Dr Ford) I was going to agree with that. It is almost
the Cinderella of Cinderella services. I feel I have got some
skills in sexual health. My skills in sexual dysfunction are much
more limited, very limited, and it was a situation where I would
ask somebody, I would ask a man who can but actually in my area
there is not anything. There is a therapist in the next PCT who
has got about a year's waiting list so I have to try and muddle
through with that person, and it is more older people but there
are quite a lot of young people who come with quite a lot of problems.
If you can deal with them then and there that is fine—and
we quite crudely try to deal with it then and there—but
if it is not dealt with it can become an increasing problem. It
is the same as STIs but the resources around sexual dysfunction
are worse and almost non-existent really, certainly in my area.
622. This brings me on to my final question.
If we talk purely about erectile dysfunction and how you can treat
that, there are a lot of restrictions on the prescription of Viagra.
There was a consultation exercise and the decision was taken not
to widen the availability. Does that suggest to you that the Government
really does regard this as the "Cinderella of Cinderellas"
and it is not really a very important problem?
(Dr Ford) Viagra can be helpful but it is not helpful
in everybody and so obviously it should be available to people
that it can help, I think. But so often what would be wrong is
that it became the solution to the wrong problem. For a lot of
men who do have dysfunction it is not about a tablet improving
the situation, I was going to say "getting it up", but
you need to look at why they are having that problem. Obviously
if it is diabetes or a very physical problem they should have
access to Viagra but it is not the panacea for everything and
should not be used as that.
Chairman
623. Women are much happier than men talking
about men's problems. I was going raise the issue of the evidence
that we received where a witness suggested that a third of men
suffer from some form of erectile dysfunction. What has struck
me with this inquiry is the extent to which women have screening
processes built in in a range of ways that men do not have. In
my own area we have a Well Women Centre, the cervical screening
programme, clinics that are giving contraceptive advice. What
are your views on the way we might better target men, who by tradition
are much more embarrassed about this area than women?
(Dr Kinghorn) Men certainly need to have assertiveness
training. I smile about this because often a lot of training takes
place with younger women but I think that there is an educational
process that needs to take place in schools about health and about
promoting health seeking behaviour. One of the places young men
access health care is the GUM clinics for matters of sexual health
which are very important at that age. It is so important to get
it right first time. If they have a positive experience when they
are seeking health care at that time then that will be a positive
influence for the future. Conversely, if they have a bad experience
this may induce further delay when they have other health events
in the future. So those of us who are going to be the first point
of call need to make sure that we provide a supportive service
for men when they come of whatever age. There also needs to be
more education in schools. You are quite right that men in general
are far less comfortable than women in terms of dealing with most
aspects of their health but particularly about their sexual health.
It terms of severity I often say to my medical students men will
consider anything wrong with their nether regions to be the next
to death in terms of importance.
(Dr Ford) There is a joke—or a serious saying—in
general practice that if any young man presents with acne he is
presenting around sex and if you do not ask about sex then you
have lost a real opportunity.
624. I must go away and think about that one.
Do any of my colleagues have any further questions or any burning
points?
(Dr Munday) I was going to make the comment that it
is extraordinarily difficult to reach men, particularly men without
symptoms, because they do not access health care from the moment
they have their last vaccination to the time they have their first
coronary, and that is an enormous period of time.
Jim Dowd
625. Saving the nation money.
(Dr Munday) Absolutely, at least in the short term.
Chairman: Can I thank our witnesses for what
has been an extremely helpful session. We are most grateful for
the written evidence and the comments you have given us today.
We have learned a great deal in this inquiry and we appreciate
your help. Thank you.
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