key: cord-329939-spa16qhz
authors: Miranda, Eduardo P.; Nascimento, Bruno; Torres, Luiz Otavio; Glina, Sidney
title: Challenges in the Practice of Sexual Medicine in the Time of COVID-19
date: 2020-05-23
journal: J Sex Med
DOI: 10.1016/j.jsxm.2020.05.013
sha: 
doc_id: 329939
cord_uid: spa16qhz

nan

Brazil has a distinct interplay between public and private health institutions. 89

Interestingly, working in both public and private institutions simultaneously is 90 not only allowed but also very common. Particularly in the field of sexual 91 medicine, most of the installed infrastructure is found within the private sector 92 and most often in a fee-for-service fashion. Therefore, the economic recession 93 together with worrying predictions has the potential to undermine both patient 94 accessibility to sexual medicine services and the income of many professionals. 95

As it is not possible to predict when routine sexual medicine practice will return, 96 the financial impact on many sexual health care providers can be dramatic. On 97 the other hand, public services have been mostly devoted to the fight against 98 COVID-19, and many sexual medicine experts who are public employees have 99 been allocated to work in the frontline or in regulation services. The reality is 100 that many public sexual medicine referral centers have been closed down, in 101 which all consultations and surgeries were cancelled and there is still no forecast 102

for their normalization. The longer this situation lasts the bigger will be the delay 103

in these elective procedures, overloading the public system. 104 105

Another significant challenge in our country is the fact that telemedicine was not 106

previously regulated. As a result, there has been an urgent need for the 107 development of new regulations and a rapid implementation nationwide. 108

However, patients, providers and insurance companies have not easily accepted 109 this process, which will probably need more time to adapt. Providers are 110 reluctant because many insurance companies are not paying for online 111

consultations. Some advocate that the use of telemedicine through expensive 112 platforms may impair the practice of local physicians, leaving its management in 113 the hands of wealthy institutions. Also, being a country where Latin culture 114

predominates, patients tend to prefer the traditional face-to-face contact and a 115 closer relationship to their caregivers. Online consultations have been refused by 116 some patients on the grounds that they might undermine the emotional bond to 117 the interviewing professional. Others have complaint about the lack of privacy 118 during remote consultations. As many families are isolated together, some 119 individuals are afraid that the conversation might be overheard exposing 120 sensitive issues such as masturbation habits, multiple sexual partners, bizarre 121 sexual practices, to name a few. 122 123

Following-up patients has also been challenging during the pandemic. Routine 124 laboratory assessments have become unnecessary exposure to contamination. 125

At home visits for diagnostic workup are expensive and unfortunately beyond 126 the financial reality of the vast majority of our population. Taken together, this 127 scenario imposes a great risk for treatment discontinuation or suboptimal care. 128

Managing complicated surgical cases has also been difficult. For instance, there 129 are reports of patients who had prolonged hospital stay or even death after 130 SARS-CoV-2 following uneventful surgical procedures 10 . To avoid exposing the 131 team, patients and family members to these risks, surgeons may feel pressured 132

to undergo more conservative measures and delay necessary in-hospital 133

interventions. 134 135

Furthermore the spread of COVID-19 has definitely impacted academic 136 endeavors in our country. As many multi-specialty academic hospitals have 137 been turned into strategic facilities to host COVID-19 patients, physicians with 138 academic functions have been transferred to frontline duties. Although 139 compensation with online activities have been proposed in some institutions, in 140 others the academic routine has been simply abandoned as a result of an intense 141 workload. The consequences to medical students, interns and residents are yet 142 unknown, and some institutions are considering cancelling the current academic 143

year. 144 145

In the research arena it has also been difficult for many training professionals 146 and grant holders, as most research activities had to be stopped or postponed. 147

On-going clinical trials that demand time-dependent patient recruitment, lab 148 assessment or office visits may face significant drawbacks. 149 150

Although COVID-19 pandemic has been very impactful in our country, 151

demanding immediate solutions, it may still create opportunities in different 152

areas. It is our feeling that some of these changes driven by the current state of 153 facts will eventually be proven effective and beneficial, being adopted in the post 154 pandemic world and perhaps changing the practice of sexual medicine for the 155 better. 156 157

As telemedicine is a reality in many countries, there is probably going to be 158 pressure for leaders to maintain the new regulations afterwards. Its use could 159 gradually become routine with better acceptance from patients and providers. It 160 is even likely that new technologies might create strategies to overcome the lack 161 of physical contact in the future. As a result, many patients could benefit from 162 having access to sexual medicine experts without the need to dislocate long 163 distances, which is particularly relevant in our country with continental 164 dimensions and limited offer of specialized professionals. As interviews are the 165 main core of sexual medicine practice, telemedicine might be more easily applied 166 within our specialty. In addition, other professionals such as psychologists and 167

nutritionists have been allowed to perform online consultations for years, and 168 their successful experience in our country could be a model for sexual medicine 169 to build on. 170 171

It is also possible that academics will experience a new concept of medical 172

conferences. It is our understanding that virtual participation will not completely 173

replace traditional conferences and symposiums, as social interactions are one of 174 the main purposes of scientific encounters. Nevertheless, hybrid events that 175 allow on-line participation for both lecturers and attendees might become an 176 interesting modality, reducing costs and increasing attendance. This new 177 paradigm could help developing multi-institutional collaborations and high 178 quality meetings everywhere. 179 180

Finally, COVID-19 is also creating research opportunities. Although the economic 181 crisis will inevitably compromise the total amount of research funds, the 182

Brazilian government has allocated resources for sponsoring research related to 183 different aspects of COVID-19. The investigation of potential sexual health 184 consequences of the pandemic is surely an opportunity in the sexual medicine 185 field, analyzing disease burden on sexual function and behavior. Understanding 186 the role of sexual transmission in COVID-19 is another aspect worth 187

investigating. 188 189 190

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