ERECTILE DYSFUNCTION
🩺 SECTION 1: DATA GATHERING
🧾 PRESENTING COMPLAINT
• 48-year-old man presents with difficulty maintaining an erection for the
past 4 months.
• Problem developed gradually; he can get partially erect but loses it midway
through intercourse.
• No penile pain, deformity, or discharge.
• Reports reduced libido and no morning erections.
• Feels stressed and embarrassed about the issue.
⚠️ RELEVANT HISTORY
• PMH: Type 2 diabetes (8 years), hypertension.
• Medications: Metformin, beta blocker (atenolol), ramipril.
• SH: Smokes 10/day, drinks alcohol socially, limited physical activity.
• FH: Father had early heart disease.
• Psychosocial: Stress at work, low confidence, partner tension due to
misunderstanding — his wife suspects he may be having an affair.
💬 ICE – IDEAS, CONCERNS, EXPECTATIONS
• Ideas: Thinks it might be stress or age-related.
• Concerns: Afraid of losing his partner’s trust and intimacy; worried this might
mean something serious.
• Expectations: Wants to know if there’s a safe and effective medication to
help.
🔬 SECTION 2: EXAMINATION & INVESTIGATIONS
PHYSICAL EXAMINATION
• BP 142/88 mmHg, BMI 30.
• Normal genital examination; no penile plaques or deformity.
• Secondary sexual characteristics normal.
INVESTIGATIONS
• Blood glucose and HbA1c – diabetes control.
• Lipid profile – vascular risk.
• Testosterone (morning sample).
• Renal function and thyroid function tests.
• ECG – before starting PDE-5 inhibitors.
🧠 SECTION 3: DIAGNOSIS
• Working Diagnosis: Erectile dysfunction likely secondary to diabetes,
vascular factors, and beta-blocker use.
• Differentials: Psychological ED, hypogonadism, medication side effects.
Patient Explanation Box:
“Erectile dysfunction is common, especially in men with diabetes and high blood
pressure. It happens when blood flow or nerve supply to the penis is reduced.
Beta-blockers can also contribute. The good news is that it’s treatable with
lifestyle changes, managing your diabetes, and safe medications like sildenafil.”
💊 SECTION 4: MANAGEMENT PLAN
A. 🏠 WHAT THE PATIENT CAN DO
• Stop smoking and limit alcohol.
• Exercise regularly and lose weight.
• Improve diabetes and blood pressure control.
• Discuss emotional stress and relationship concerns openly with partner.
B. 👨⚕️ WHAT THE GP WILL DO
• Review antihypertensive medication – consider changing from beta-blocker
to alternative agent.
• Offer PDE-5 inhibitor (Sildenafil 50mg as needed) if cardiovascular status is
stable.
• Check testosterone and other lab results.
• Offer psychosexual counselling if anxiety is contributing.
• Provide education and reassurance regarding medication safety and
effectiveness.
C. 📅 FOLLOW-UP & SAFETY NETTING
• Review in 4–6 weeks to assess response and side effects.
• Refer to urology if non-responsive or if organic cause suspected.
• Advise to seek urgent help if chest pain or fainting occurs after medication.
REFERENCES
• NICE CKS – Erectile Dysfunction (2024)
• NHS – Erectile Dysfunction Overview
• [Link] – Erectile Dysfunction
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