Erectile Dysfunction: What We Do, and What Comes First

Men ask about this quietly, often at the end of an appointment about something else, so here it is written down.

The medical part comes first, and it is important. Erectile dysfunction that has come on gradually is one of the earliest signs of cardiovascular disease, because the small blood vessels are affected before the ones that cause chest pain. It is also an early sign of type 2 diabetes and a side effect of many common medications. A GP appointment should cover blood pressure, glucose or HbA1c, lipids and a medication review. Skipping that and going straight to a tablet treats the symptom and ignores what it is telling you.

See a doctor promptly, not eventually, if it started suddenly, followed an injury or surgery, is painful, involves a new curvature, or comes with low libido and fatigue.

What actually works. Oral medication, for most men. Treating blood pressure, glucose, weight, alcohol, smoking and sleep apnoea. And where the cause is psychological or relational, a psychologist or sex therapist — a GP mental health treatment plan subsidises it.

The honest limit of what we do. The evidence for acupuncture in erectile dysfunction is weak. We are not going to present it as a treatment. What we can work on is sleep, the physical side of stress, and pain that has stopped someone exercising — and exercise genuinely matters here. If you want a herbal preparation, we need your full medication list first, because some interact seriously with nitrates and blood pressure medication.

The other things worth raising in the same appointment, since men tend to bring one item and leave with five. A weak urinary stream or getting up at night, which needs a prostate assessment. Low libido with fatigue, which is a morning blood test. Premature ejaculation, which is common and treats well. And a testicular lump, which needs assessing that week — sudden severe testicular pain is an emergency department, because torsion is measured in hours rather than days.

We are in Freshwater, ten streets from Balgowlah and about twenty from Manly. Appointments are private and nothing is discussed with anyone else.