Erectile dysfunction
Erectile dysfunction is frequently the first presenting sign of vascular disease, and can also reflect hormonal, medication-related or psychological causes. Treating the symptom without evaluating the cause misses the point of the consultation.
What a provider evaluates
- Cardiovascular risk factors, blood pressure and exercise tolerance
- Nitrate use — an absolute contraindication to PDE5 inhibitors
- Testosterone, where symptoms suggest a hormonal contribution
- HbA1c and lipids, since diabetes and dyslipidaemia are common contributors
- Current medications, several classes of which contribute
- Psychological and relationship factors
What treatment may involve
- A PDE5 inhibitor, on demand or as a low daily dose
- Investigation and management of an underlying contributor
- Referral where specialist assessment is appropriate
Whether any of these is appropriate is determined by a licensed provider after reviewing your history and laboratory results.
Medications a provider may consider
Markers on this panel
What each marker measures and why your provider tracks it.
Questions about erectile dysfunction
Tadalafil or sildenafil — what is the difference?
Both are PDE5 inhibitors. Tadalafil has a much longer half-life, which allows either on-demand use or a lower daily dose; sildenafil is shorter-acting and taken on demand roughly an hour beforehand, with onset delayed by a heavy meal. Side-effect profiles differ slightly. Neither may be combined with nitrates under any circumstances. Which suits you is a clinical decision based on frequency of use, other medications and tolerance.
Can erectile dysfunction be a sign of something else?
Yes, and this is the reason evaluation matters. Erectile dysfunction is frequently an early marker of vascular disease, and can also reflect diabetes, low testosterone, medication side effects, sleep apnoea or psychological factors. Treating the symptom without assessing the cause can mean missing something more consequential. A provider will review cardiovascular risk factors and relevant laboratory work as part of the evaluation.