Erectile dysfunction

Question 1

Questions to ask in HPC

Answer 1

Onset and duration
Previous erection quality
Erections at other times
Urinary symptoms
Hypogonadism (loss of secondary sexual hair/libido loss/fatigue)

Is it a problem initiating erections or maintaining them?

Relationship status
Mood
Weakness/parasthesia
History of trauma or surgery in that area

Question 2

Questions to ask in PMH

Answer 2

Diabetes
Hypertension
Urological problems

Question 3

Questions to ask in DH

Answer 3

Any antihypertensives or beta blockers, diuretics, antipsychotics, antidepressants

Question 4

Cause of ED

Answer 4

Often multifactorial - psychogenic and organic components

Question 5

Lifestyle management

Answer 5

Smoking cessation
Alcohol reduction
Exercise
Weight loss

Question 6

Drug to offer

Answer 6

Sildenafil (Viagra) - PDE-5 inhibitor

Question 7

Counselling to give about Viagra

Answer 7

Not to be taken with a nitrate drug

Side effects - headache, flushing, dizziness, dyspepsia and rhinitis

If an erection lasts more than 4h - go to A+E - risk of priapism

Still need stimulation to get an erection

Question 8

Other important history aspects

Answer 8

Smoking and alcohol
Psych history
Any relationship stress
FH of CV disease

Question 9

Tests that can be arranged

Answer 9

Blood tests - fasting lipids, HbA1c, testosterone, LH, SHBG, glucose

BP

Question 10

Do they need follow up

Answer 10

yes in 6-8w

Question 11

Safety netting

Answer 11

If get an erectile longer than 4h go to hospital

or symptoms of haematuria, weight loss, fatigue, other cancer symptoms - come back to GP

Question 12

Refer if

Answer 12

Medication not working, low testosterone