What initial assessments should I perform for a patient presenting with erectile dysfunction?

For a patient presenting with erectile dysfunction (ED), the initial assessment should include a comprehensive clinical history focusing on the onset, duration, and severity of symptoms, as well as any associated factors such as psychological, relational, or medical conditions. This history should explore cardiovascular risk factors, medication use, lifestyle factors (e.g., smoking, alcohol, cycling habits), and any history of pelvic or genital trauma. A focused physical examination should include assessment of the abdomen, external genitalia, and a digital rectal examination to evaluate the prostate and detect any structural abnormalities. Basic investigations should include measurement of blood pressure and consideration of blood tests to assess testosterone levels and other relevant hormones (e.g., FSH, LH, prolactin) if hypogonadism is suspected. Additionally, review current medications to identify any that may contribute to ED. Urinalysis may be considered to exclude diabetes or infection. Psychological assessment is important to identify any psychogenic causes or mental health conditions. If there is evidence of priapism (painful erection lasting more than 4 hours), urgent hospital admission is required. Referral to specialists (urology, endocrinology, cardiology, or mental health services) should be considered based on findings such as young age with lifelong ED, suspected hypogonadism, high cardiac risk, or complex psychological issues. Lifestyle advice on weight loss, smoking cessation, alcohol reduction, and exercise should be offered as part of the initial management plan. This integrated approach aligns with UK clinical guidelines and is supported by recent literature emphasizing a biopsychosocial model for ED assessment ¹ (Nicol and Chung, 2023).