By Timothy C. Hlavinka, MD
It’s 7:15 a.m. My wife pulls out of our driveway to begin her second carpool of the morning. I follow her up the driveway in my own car on my way to work. I don’t know how she does it. She’s amazing. Silently I bless her and all physicians’ spouses.
I am running a little late, as always. My partners say I was born late, but that’s not true. I was actually born a preemie—probably the only time in my life I’ve been early. Being more punctual was my New Year’s resolution, but only a few months into 2007, I’m already faltering.
My first patient of the morning is an elderly man. He is a new patient with symptoms that suggest enlarged pro-state. I introduce myself, and immediately there is the requisite query about my name. Yes, the H is silent. No, it’s not Finnish; it’s Czech. And in fact, it means small head. My patient and I share a laugh when the meaning of my moniker is related to my chosen profession of urology. Although I treat all types of urologic problems, my focus increasingly has become sexual dysfunction (in both genders) and neurourology.
Next, I see a young man in a wheel chair. He’s been a quadriplegic since age 18 yet still lives independently. His condition is the result of reckless choices we all make at that age. Like many patients with spinal cord injuries, he suffers from a neurogenic bladder, where the nerves of the urinary system don’t work properly when the bladder is full. For several years, his condition has been well managed with medication, but recently he has increased morbidity, prompting him to ask about new options to improve his quality of life.
I explain the use of Botox injected into the bladder tissue to paralyze the muscle and control spasmodic contractions. This relatively new treatment has been an exciting adjunct to my practice. Another option to consider is sacro-neurostimulation (InterStim). This therapy involves the placement of a pacemaker that sends painless electrical impulses to the sacral nerves that regulate bladder function. A final option is to teach him how to catheterize himself, a prospect that can be limiting for a young, high-spirited man. I encourage him to take his time considering his options and invite him to a seminar where he can learn more and speak with other patients who have undergone these treatments.
As he leaves, I reflect on the responsibility of caring for the less-abled who comprise a significant portion of my practice. Taking care of these individuals is a challenge, but their challenges are greater than mine. They make more effort to get the afternoon mail than the fully-able make in an entire day. These patients help me keep my perspective and show me how quickly life
can change.
Later that morning, I have an appointment with a late middle-age couple. The man has been my patient for about six years. On his first visit, I prescribed him Viagra. But little did I know then that his post-menopausal spouse was suffering from low desire and vaginal dryness, a common and treatable problem. Needless to say, she was less than eager to have Papa “fully equipped” again.
In light of the medical community’s growing understanding of and appreciation for female sexual medicine, I recognize now that Viagra is a two-person prescription, and I make it a point to speak with both partners about sexual issues. Communication about sexuality is hard enough when both partners are in the same room; it’s impossible when they
are not.
I comfort the couple by telling them that the impact of sexual problems in a relationship tends to have the same dynamic in a couple regardless of which partner is most affected. I encourage them to seek solutions together. The similarities in genders greatly outweigh the differences when it comes to sexual dysfunction.
It wasn’t always easy to talk to patients about sexuality. When I started my practice, I’d blush when a woman my mother’s age talked about sexual issues. But I realized I was doing my patients a disservice and resolved to become more comfortable with these problems. Today, conversations about sexual dysfunction are similar to discussing voiding symptoms or incontinence. Sexuality is an important issue to discuss.
In addition to facilitating communication among partners, I am closely involved in advocacy and research aimed at providing solutions for women’s sexual difficulties. My patients and I discuss the importance of ensuring they are physically prepared for sexual encounters, and I often recommend hormonal testing at our Center for Female Sexual Medicine. They may benefit from oral or topical hormone supplements to boost desire, or perhaps they are candidates for research protocol evaluating one of many potential therapies.
The complex nature of sexual issues and neurourology means that most of my appointments have taken longer than scheduled. I struggle the rest of the day to give every patient the time and attention they need while still keeping up with a full schedule of appointments.
At the end of the day, I finish my paperwork and head home. I had intended to get home in time to watch the gorgeous Helotes sunset from my back deck, but I guess punctuality will stay on my resolution list for quite some time in
the future.
Dr. Hlavinka practices with Urology San Antonio. In 2004, he was instrumental in leading the practice to launch its Center for Female Sexual Medicine, the first clinic in South Texas devoted to helping women identify and treat the medical factors affecting their sexual health. Dr. Hlavinka serves as co-director of the center.
