Introduction

Learning objectives

Perform the initial evaluation of a patient with erectile dysfunction at the primary care level.
Recognize the criteria that justify referral to a specialist.
Understand erectile dysfunction as an opportunity to detect cardiovascular risk.

Video lesson

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Video pending upload (embedded YouTube)

Summary

Erectile dysfunction is the persistent difficulty in achieving or maintaining an erection sufficient for satisfactory sexual activity.

Initial evaluation

Investigate:

characteristics of the problem;
sexual desire;
spontaneous erections;
diabetes;
hypertension;
obesity;
dyslipidemia;
smoking;
medications;
pelvic surgery;
psychological and relationship factors.

When to refer?

uncertain diagnosis;
young patient with no obvious cause;
penile deformity;
suspected Peyronie's disease;
hypogonadism or another endocrine disorder requiring workup;
failure of or contraindication to initial treatment;
need for intracavernosal or surgical treatments;
dysfunction after surgery or trauma.

Clinical pearl

Erectile dysfunction can be an opportunity to detect cardiovascular and metabolic risk factors.

PDF

⬇ Download lesson summary

Downloadable PDF pending upload.

Practical algorithm

🔴 Urgent referral / emergency

Sudden testicular pain → rule out torsion.
Fever/sepsis + obstructed urinary tract → urgent urinary drainage.
Acute urinary retention → bladder decompression; urgent referral if it cannot be resolved or if complications are present.
Hematuria + clot retention → urgent assessment and management.
Trauma + suspected urethral injury → avoid repeated blind catheterization attempts.

🟠 Priority referral

Solid testicular mass → rule out tumor.
Suspicious renal mass → characterization and urologic evaluation.
Gross hematuria → investigate the cause.
Persistently elevated PSA/suspicious DRE → prostate cancer risk assessment.

🟢 Scheduled referral depending on context

Recurrent UTI → look for a predisposing cause.
Erectile dysfunction → refer if complex, refractory, or with associated pathology.
Urinary incontinence → refer if complex, if warning signs are present, or if initial management fails.

The primary care physician does not need to resolve all urologic pathology. They must know how to perform an initial evaluation, recognize warning signs and, above all, distinguish which patient can wait from the one in whom a delay may compromise an organ, renal function, or even life.

Clinical case

Content pending upload Progressive clinical case focused on decision-making.

Self-assessment

Questions pending upload 5–10 multiple-choice questions on this lesson.

References

Links pending upload References to PubMed, DOI, scientific society guidelines and journals.

Erectile dysfunction