Erectile Dysfunction

GGC - Primary Care
NHS GGC

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GGC Medicines: Drugs for genito-urinary disorders

Primary care assessment

  • History: Psychological, organic or mixed: onset, duration, situational, morning erections, trialled therapy, previous pelvic surgery, trauma. Underlying cause
  • Examination: General examination including BP and waist circumference, neurological examination and CVD. Assess for metabolic syndrome and secondary sexual characteristics. Genitals: hypogonadism, phimosis, penile lesions and penile plaque. Digital rectal examination
  • Investigations: HbA1c, lipid profile, testosterone +/- Prolactin, consider PSA. IIEF short form or SHIM form.1

Red flag symptoms present

  • Abnormal DRE/PSA
  • New penile lesions/persistent penile lesion despite treatment
  • Penile mass
  • Significant risk of cardiovascular disease/unstable angina
  • Consider discussion with on call urology if penile trauma (penile fracture)

Lifestyle advice

  • Identifying underlying risk
  • All changes as effective in improving erectile function:
    • Weight loss
    • Exercise
    • Smoking cessation
    • Improved diet
  • Commence treatment for underlying condition (diabetes, hyperlipidaemia and cardiovascular disease)2

Initial treatment

  • All patients should have access for psychosexual counselling
  • Younger patients (<35):
    • Ensure no underlying organic conditions
    • Refer for psychosexual counselling
    • If situational – counsel against use of pornography
  • Ensure patient is fit to resume sexual activity (Princeton III Consensus3). If intermediate to high risk should be referred to cardiology
  • Commence PDE5i of choice, considering patients sexual habits, and counsel RE side effects and optimisation.  GGC Medicines: Drugs for genito-urinary disorders

Criteria for secondary referral to Andrology

  • Underlying malignancy (USOC)
  • Associated penile lesion (USOC)
  • Anatomical cause identified – phimosis or Peyronie’s Disease (Routine)
  • Treatment failure – 2x PDE5i at maximum dose on 6 occasions (Routine)
  • Patient preference – patient does not want to try medical therapy (Routine)
  • Underlying endocrine cause – joint referral to urology/endocrine (Routine)

References

  1. EAU Guidelines – Sexual and Reproductive Health 2025
  2. Gupta et al “The effects of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis” Arch Intern Med 2011
  3. Nehra et al “The Princeton III Consensus Recommendations for the Management of Erectile Dysfunction and Cardiovascular Disease” Mayo Clin Proc 2012

Editorial Information

Last reviewed: 12/08/2025

Next review date: 30/06/2026

Author(s): Consultant Urologist.

Version: 1

Approved By: Urology South and North Sector