Physicians' response to sexual dysfunction presented by a younger vs. An older adult

Aim: The aim of this study is to determine whether physicians have an age bias regarding sexual dysfunction presented by older vs. younger patients in terms of attributed diagnosis, etiology, proposed treatment and perceived prognosis. Method: An on-line survey consisting of one of two, randomly administered, case vignettes, which differed only by the age of the patient (28 or 78). In both cases, the patient was described as suffering from occasional erectile dysfunction with a clear psychosocial indication. A total of 236 physicians responded to the survey. Overall, 110 physicians received an “old” vignette and 126 physicians received a “young” vignette. Results: Even though both cases presented with a clear psychosocial etiology, the “older” vignette was more likely to be diagnosed with erectile dysfunction whereas the “younger” vignette was more likely to be diagnosed with performance anxiety. The “older” vignette's dysfunction was more likely to be attributed to hormonal changes, health problems and decreased sexual desire. Physicians were more likely to recommend testosterone replacement therapy (TRT) and PDE5 inhibitors (PDE5i; such as Sildenafil; Vardenafil; Tadalafil) as well as a referral to urology to the “older” vignette. In contrast, the “younger” vignette was more often referred to a sexologist and received a more positive prognosis than the older patient. Conclusions: This study demonstrates an age bias among physicians regarding sexuality in later life. Of particular note is the tendency to prescribe PDE5i to the older patient, despite the clear psychosocial indication presented in the case vignette.