Erectile Dysfunction

HISTORY:

Erectile difficulty for ‍ ‍hoursdays

Type: ‍difficulty achieving erectiondifficulty maintaining erection

Severity: ‍mildmoderateseverecomplete, ‍causingnot causing significant distress

Pattern: ‍persistentintermittent

Worsening factors: ‍none

Treatments tried: ‍none, ‍effectiveineffective

‍premature ejaculation

‍delayed ejaculation

‍anorgasmia

‍reduced libido

‍pain with intercourse



EXAM:

General appearance: ‍well-appearing

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Neck: ‍normallymphadenopathy

Heart: ‍RRR, ‍normal S1 and S2

Lungs: ‍clearabnormal sounds, ‍retractions

Abdomen: ‍softsemi-softtense, ‍non-tender ‍, ‍non-distended, ‍

Genital: ‍normal, testicles ‍normal, penis ‍normal



ASSESSMENT:

‍Erectile dysfunction ‍likelysuspectedpossible

DDx: ‍



PLAN:

- Blood work: ‍CBC, ‍glucose, ‍lipids, ‍TSH, ‍testosterone, ‍prolactin, ‍LH, ‍FSH

- Urinalysis

- Doppler ultrasound of the penis

- Lifestyle modifications: ‍healthy diet, ‍regular exercise, ‍weight loss, ‍quit smoking, ‍limit alcohol, ‍reduce stress

- ‍PDE5 inhibitors

- ‍Testosterone replacement therapy

- ‍Alprostadil

- Vacuum erection device

- Penile implant

- Referral to urologist

- Referral to endocrinologist

- Referral to psychologist

- Follow-up in ‍ ‍weeksmonths

- Return if erectile difficulty worsens, if new symptoms develop such as pain or curvature of the penis, or if emotional distress occurs

- Go to ER if priapism (erection lasting more than 4 hours) occurs