Clinical summary guide

Erectile dysfunction

6 min

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The GP’s role

GPs are typically the first point of contact for men with erectile dysfunction.

The GP’s role in the management of erectile dysfunction (ED) includes clinical assessment, treatment including counselling, medication, referral and follow-up as needed.

Overview

How to approach the topic with patients

“Many men (of your age/with your condition) experience sexual difficulties. If you have any difficulties, I am happy to discuss them”.

“It is common for people with diabetes/heart disease/high blood pressure to have erectile problems. Also, erectile problems can indicate you are at higher risk for future health problems such as heart disease. So it’s an important issue for us to discuss if it is a problem for you”.

Diagnosis

History

MedicalSexualPsychosocial
LifestyleDefine the nature of the sexual dysfunctionDepression
General healthED onsetAnxiety
Chronic diseaseSpontaneous morning erectionsRelationship difficulties
Genital diseasePenetration possibleSexual abuse
MedicationsMaintenance of erection
Pelvic surgery/radiation

Management

Treatment summary

Treatment

1st line treatment

2nd line treatment

Low intensity shock wave treatment

There is weak evidence to support the use of low-intensity shockwave therapy for treatment of vasculogenic erectile dysfunction. Although it has minimal risk, patients should be counselled about its effectiveness and suitability.

Patient comfort and education are essential. Inform patient of side-effects (priapism, pain, fibrosis and bruising, particularly if on blood-thinning agents). Provide a plan for urgent treatment of priapism if necessary.

3rd line treatment

Possible emerging treatments

Referral 

Clinical review

Dr Gideon Blecher, Alfred Health

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Erectile dysfunction

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