Erectile Dysfunction

Who to refer

  • PDE5 failures and CIs only
  • Those with penile deformity (ask patient to bring photos of erect penis to OPA) 
  • For those with ED and hypogonadism (Testosterone below normal range) refer to endocrine dept. for consideration of supplementation 
  • Caverject/Muse therapy undertaken in Urology OPA in the absence of a specialist ED clinic currently.


Primary Care Workup

  • Incidence of ED is approximately proportional to age, ie. 60% of 60y olds, with half that number severely affected. ED aetiology is usually a combination of organic and psychological causes.  
  • ED itself is a cardiovascular risk factor conferring a risk equivalent to a current moderate level of smoking (HR 1.46) 
  • The pro-active management of ED in the cardiovascular patient provides an ideal and effective opportunity to address other cardiovascular risk factors  
  • Mainstay of contemporary treatment is with PDE5i that can be instigated in primary care. 


Initial assessment  

  • Medical & psychosexual hx. Examination to include penile deformity?, BP and gross neuro exam, peripheral vascular exam.
  • Baseline tests: fasting glucose, lipids, Free Androgen Index (test profile- testosterone, SHBG & Free Androgen index) between 9-11am.” “If Free Androgen Index is low or borderline then repeat it (between 9am-11am) and also test for FSH, LH and Prolactin. If considering testosterone replacement then also test PSA.


Management prior to referral:

  • Modifiable lifestyle changes
  • Consider changing drugs associated with ED
  • Psychosexual counselling where relevant (RELATE)
  • Beware CI, concomitant nitrate use
Insertion of penile prosthesis is not routinely commissioned by NHS Kernow 
Vacuum pumps can be purchased from reputable medial suppliers, see www.sexualadviceassociation.co.uk/pump
PDE5i therapy
All PDE5i similar efficacy overall, individual responses vary
Try Viagra & Cialis & Levitra at maximum dose x8 each drug taken 1-2x/week before declaring failure
Where PDEi successful subsequently titrate down dose
NICE CKS Erectile Dysfunction. Dec. 2017  https://cks.nice.org.uk/erectile-dysfunction



Mr Christopher Blake, Consultant Urologist, RCHT

Dr Stephanie Jackson, GP Lead Urology


Reviewed: July 2018