Erectile Dysfunction Workup for 58-year-old Male

This 58-year-old male patient presents with erectile dysfunction (ED), a common condition with various potential causes. Here’s a breakdown of the initial workup and considerations:

History:

• ED Severity: Assess the duration, frequency, and severity of ED. Is it complete or partial? Does it occur with all partners or only specific situations?
• Medical History: Focus on conditions that can contribute to ED like diabetes (present), hypertension (present), and any history of vascular disease, neurological disorders, or pelvic surgeries.
• Medications: Review current medications, including Metformin and Lisinopril, which can have side effects of ED. Explore potential interactions with other medications or supplements.
• Lifestyle: Assess smoking, alcohol consumption, and drug use. Consider any psychological stressors like the reported work stress.
• Sexual History: Explore past sexual history, frequency of intercourse, and any history of sexually transmitted infections (STIs).

Physical Exam:

• The current exam focuses on the genitourinary system, but a more comprehensive physical exam might be warranted depending on findings.
• Assess for any abnormalities in the genitals (already documented as normal).

Initial Investigations:

• Urinalysis (UA): While normal in this case, a UA can rule out urinary tract infections (UTIs) that might contribute to ED symptoms.
• Blood Tests: Consider tests like:
  • Testosterone levels: Low testosterone can contribute to ED.
  • Glycemic control: Monitor hemoglobin A1c (HbA1c) to assess diabetes management.
  • Lipid profile: Evaluate cholesterol levels, as high cholesterol can affect blood flow.

Next Steps:

Based on the initial workup, further investigations or management strategies might be considered:

• Lifestyle Modifications: Encourage smoking cessation, moderate alcohol intake, and stress management techniques.
• Medication Adjustment: Review current medications and discuss potential adjustments or alternative options with minimal ED side effects.
• Addressing Underlying Conditions: Optimize diabetes and hypertension control.
• Psychological Evaluation: If stress is a significant contributing factor, consider referral for therapy.
• Phosphodiesterase-5 (PDE5) Inhibitors: Consider medications like Viagra or Cialis if appropriate for the patient and after addressing potential contraindications.

Conclusion:

A comprehensive workup for ED in this case requires further investigation into the patient’s medical history, medications, and lifestyle factors. Based on the findings, various treatment options may be explored, with the goal of restoring erectile function and improving the patient’s sexual satisfaction.