Erectile Dysfunction

Age: ‍ years old

Gender: female



HISTORY:

Presents with a ‍-‍month history of erectile difficulty

Severity of the issue: ‍mildmoderateseverecomplete, ‍causingnot causing significant distress

Pattern: ‍persistentintermittent

Type: ‍difficulty achieving erectiondifficulty maintaining erection

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍premature ejaculation

‍delayed ejaculation

‍anorgasmia

‍reduced libido

‍pain with intercourse



Contributing factors:

‍smoking

‍alcohol use

‍substance abuse

‍obesity

‍low physical activity

‍psychological stress

no history of: ‍depression, ‍anxiety, ‍hypertension, ‍diabetes, ‍cardiovascular disease, ‍neurological disorders, ‍prostate disease, ‍psychiatric disorders

no use of: ‍antihypertensives, ‍antidepressants, ‍anxiolytics, ‍new medication





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

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

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Anorectal: DRE ‍normal, prostate ‍normal, ‍blood, ‍mass, anus ‍

Genital: penis ‍normal, testes and epididymis ‍normal, ‍inguinal hernia





ASSESSMENT:

‍Erectile dysfunction ‍likelysuspectedpossible

DDx: psychogenic erectile dysfunction, vasculogenic erectile dysfunction, neurogenic erectile dysfunction, hypogonadism, drug-induced erectile dysfunction, anatomical erectile dysfunction, penile trauma or injury, Peyronie's disease, chronic illness, lifestyle factors, cardiovascular disease, diabetes mellitus, hypertension, hyperlipidemia, obesity, metabolic syndrome, chronic kidney disease, liver cirrhosis, neurological disorders, endocrine disorders, thyroid disease, pituitary disorders, psychological conditions, depression, anxiety, stress, relationship issues, substance abuse, alcoholism, antidepressants, antipsychotics, prostate cancer treatments, radiation therapy to the pelvic region





PLAN:

Investigations:

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

- Urinalysis

- Doppler ultrasound of the penis

Treatments:

- 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

Further care:

- 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

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