E rectile dysfunction is a common, but treatable, condition. Where appropriate, modification of lifestyle factors, medication optimisation and oral pharmacotherapies can be initiated in primary care. Early recognition and management will improve the quality of life of affected individuals and partners, and may avert relationship problems, negative body image and poor mental health. Erectile dysfunction is also an important early warning sign for conditions such as cardiovascular disease. This article considers the aetiology and risk factors for erectile dysfunction, identifies common clinical features, outlines primary care assessment and treatment, and discusses referral criteria. Treatment options available in secondary care are also reviewed. The GP curriculum and erectile dysfunction Clinical module 3.07: Men's health requires GPs to:. Know that erectile dysfunction is an early warning sign for many conditions including coronary vascular disease, diabetes, depression and lower urinary tract symptoms, occurring on average 3 years prior to the onset of such medical problems Clinical module 3.08: Sexual health requires GPs to:. Understand that sexual health problems have physical, psychological and social consequences Definition of erectile dysfunction Erectile dysfunction is defined as the inability to achieve and maintain a penile erection adequate for satisfactory sexual intercourse (British Society for Sexual Medicine, 2017). It is distinct from ejaculatory and orgasmic problems, which require different investigation and treatment pathways. There is no consensus in terms of duration of symptoms experienced before a diagnosis can be made and treatment commenced. The World Health Organization (World Health Organization (WHO), 2010) highlights that 'sexual health is fundamental to the physical and emotional health and wellbeing of individuals, couples and families, and to the social and economic development of communities and countries'. Prevalence and incidence of erectile dysfunction There are few studies that have estimated the prevalence and/or incidence of erectile dysfunction. A cross-sectional study of 13 primary care practices in London found that 8.8% of 18-75 year-old male registered patients had an ICD10 (International Classification of Diseases, 10th edition) clinical diagnosis of erectile dysfunction (Nazareth, Boynton, & King, 2003). Another study suggested that 20% of Australians over the age of 40 years experience erectile dysfunction (Kirby, Piterman, & Giles, 2009). The Massachusetts Male Aging Study, a community-based prospective observational survey of men aged 40-70 years, found that 52% of men self-reported erectile dysfunction (Feldman, Goldstein, Hatzichristou, Krane, & McKinlay, 1994). The same study estimated the incidence in men who were followed up for 8.8 years and found an association between erectile dysfunction and age. This is confirmed by a recent review of epidemiological erectile dysfunction literature (Eardley, 2013). The wide variation of prevalence estimates across studies...
