lcp
We have detected you are using Internet Explorer. To provide the best and most secure experience, please use a modern browser as we do not support Internet Explorer.

Clinical Opal - Investigating Erectile Dysfunction

12 April 2023 - Dr Simon Morgan

Patrick is a 62 year old university lecturer who presents to you with erectile dysfunction. He states that for the past 12 months his erections have become weaker and at times he is unable to have satisfying sex with his wife.

On further questioning, Patrick is otherwise asymptomatic and denies feeling anxious or depressed. He recalls no clear precipitant to the onset of his ED. He has a very close and supportive relationship with his wife and states that his libido is normal. 

Patrick has a background of hypertension, well controlled on irbesartan 150mg daily, and osteoarthritis of the knees. He denies any significant other past medical history and takes no other medication apart from the odd Panadol. 

What investigations would you order to investigate Patrick’s erectile dysfunction?

 

ED is a persistent or recurrent inability to attain and/or maintain a penile erection sufficient for satisfactory sexual activity and intercourse.1 It is a common condition affecting 1 in 5 men over the age of 40 years and is closely associated with cardiovascular disease and diabetes.

Clinical guidelines on the assessment and management of erectile dysfunction were published in the MJA in 2022.(2)

These stated that laboratory testing should include fasting glucose and lipid profile in all cases. 

They recommended that case finding for hypogonadism by ordering a total testosterone level should only occur in selected cases of men with ED, including when associated with:

  • Low libido

  • Incomplete response to oral phosphodiesterase type 5 inhibitor (PDE5i) treatment, and/or 

  • Type 2 diabetes.

They also stated that other tests such as FBC, EUC, urinalysis, TSH, FSH/LH, SHBG and prolactin should only be added if dictated by the clinical context.

Vascular imaging and neurophysiological testing are not required unless specifically indicated e.g. for young age, known history of pelvic trauma, and/or in the setting of abnormal examination findings. 

References

1. Health Male clinical summary guide: Erectile dysfunction

2. Chung E, Lowy M, Gillman M, Love C, Katz D, Neilsen G. Urological Society of Australia and New Zealand (USANZ) and Australasian Chapter of Sexual Health Medicine (AChSHM) for the Royal Australasian College of Physicians (RACP) clinical guidelines on the management of erectile dysfunction. Med J Aust. 2022 Sep 19;217(6):318-324. 

Testing testing 1, 2, 3

Dr Simon Morgan
Dr Simon Morgan

Simon is a GP based in Newcastle, NSW, and a senior medical educator with Medcast.  He also has medical education roles with the RACGP and GPSA.

Over the past three decades, Simon has worked in clinical and educational roles in NSW and the NT, as well as in the Republic of Ireland. He has published over 75 peer reviewed journal articles, and in 2018 received the RACGP Corliss award for his contribution to medical education.

Simon is passionate about high quality education and training. He has particular interests in GP supervisor professional development and the rational use of tests and medicines. He is a proud member of Doctors for the Environment. He spends his spare time drinking craft beer and pretending that he is a musician in the Euthymics, an all-GP band.

Read more
Get Medcast Plus

Become a member and get unlimited access to 100s of hours of premium education.

Learn more
Latest News
Optimising paediatric Eczema Care: A Nurses’ Guide
Brand icon

Explore essential strategies and insights for managing paediatric eczema effectively in this guide. From daily skincare routines to addressing common triggers and mental health considerations, empower families with the knowledge and tools to improve their child's quality of life.

5 mins READ
Men’s health behaviours - Clinical opal

Gender influences individuals’ health behaviours and their use of health services. This translates into a high burden of disease in males due to the contribution of modifiable risk factors. Helping men understand how their behaviour influences their health, and what they can do to change it, may help them to live longer, healthier lives.

5 mins READ
Medcast Partners with the University of Wollongong to Combat Antimicrobial Resistance

Medcast is thrilled to announce a new collaboration with the University of Wollongong’s Graduate School of Medicine. The $2.7M MRFF grant focuses on reducing the inappropriate prescription of antibiotics, a key factor in the development of antimicrobial resistance (AMR).