Erectile dysfunction

Differential diagnosis

  • Diabetes – polyuria, polydipsia
  • CV disease – smoking, blood pressure, BMI, cholesterol
  • Low testosterone – reduced libido
  • UTI – dysuria, frequency


Data gathering

  • Red flags – urinary symptoms, haematuria, polyuria/polydipsia, recurrent infections
  • Others – early morning erections, masturbate, CV/neuro/cancer/psych disease
  • Examine – BP, HR, BMI, prostate, external genitalia


Clinical management

  • Investigations
    • Bloods – fasting glucose, cholesterol, testosterone
  • Explanation
    • ED usually due to poor blood flow to penis. Common causes include: narrowing of blood vessels due to fatty plaques, psychological reasons. Smoking and alcohol can contribute. Other medical conditions can also lead to ED – diabetes, HTN, medications, neurological problems, low testosterone, CV disease
  • Treatment
    • Lifestyle – weight loss, exercise
    • Psychosexual counselling
    • Sildenafil – You should take one tablet about an hour before you plan to have sex, although it may still be effective up to five hours after taking the tablet. Start on 50mg but can increase the dose as required
  • Follow-up / Safety-net – can try alternative medications or refer


Sildenafil CI – nitrates inc GTN, severe liver/renal disease, recent MI/stroke