Erectile Dysfunction
#sexualhealth
up:Clinical Resources Top
- Important takeaway is that erectile dysfunction is an independent risk factor for cardiovascular disease.
- It can be quite tricky as it is a consultation where there is often an agenda mismatch from the start.
- Remember new evidence and guidance to do a testosterone test in all men (fasting between 9-11am) as PED5i drugs may not work in testosterone deficiency
Quick Reference
Link to redwhale article on erectile dysfunction n.b requires access
CKS section on what bloods to check and what bloods to consider
Useful CKS sections - link should take you to appropriate section
Drugs that can cause or exacerbate symptoms
- also see below on paper about antihypertensives and ED
Cardiac risk stratification
NHS prescription criteria - Remember generic sildenafil can be prescribed without restriction
Table of Pharmacokinetics of each PED5i's
Managing non-responders to PED5i - page 15-16 of BSSM guideline
- In brief "Patients should be exposed to a minimum of 4 (preferably 8) of the highest tolerated dose of at least 2 drugs (taken sequentially, not concurrently) with adequate sexual stimulation"
Patient information
British association of urological surgeons website PIL
British association of urological surgeons leaflet on sildenafil to sent out to patients (pdf)
Very good but quite in-depth leaflet including 'homework' for patients from CWNL (Central and North West London) Better Sex Leaflets "worried about staying hard"
Further Reading
The 2017 full guideline from the BSSM (British society of sexual medicine) https://bssm.org.uk/wp-content/uploads/2023/02/BSSM-ED-guidelines-2018-1.pdf is excellent reading but it is 28 pages long.
Bits I found particularly interesting.
- Table 2 (page 4) for Metabolic equivalents to sexual activity
- Depression and ED statement (page 6) "suggesting that depression is a likely consequence of ED"
- Lifestyle Modification (page 8) - probably the most important section given the association with CVD.
- Figure 2 (page 9) for guidance on testosterone screening
- Table 9 (page 12) drugs that may contribute to erectile dysfunction
- Daily Tadalafil and LUTS (page 17) - interesting but not currently recommended by NICE
Interesting paper about antihypertensive and erectile dysfunction
Click here to be taken to most useful table in paper
The Effect of Antihypertensive Drugs on Erectile Function: A Proposed Management Algorithm - PMC (nih.gov)