REMEDY : BNSSG referral pathways

Erectile Dysfunction

Checked: 24-01-2017 by christopher.moloney Next Review: 28-12-2018

Principles of Management

Erectile dysfunction can normally be managed in primary care.  The CKS Guidelines (web page) are helpful in guiding this. 

In addition there is some local guidance on prescribing PDE 5 Inhibitors (PDF).  Referral to secondary care does not bypass need to adhere to NHS prescribing restrictions for PDE5 inhibitors (although these have now been lifted for generic sildenafil).  Only refer if complex or failed drug treatment with at least 2 drugs at maximum doses.

Anejaculation is best managed by psychosexual therapy.  For further details see Bristol Sexual Health Services (web page).  No Urological Intervention is needed.

Clinical Guidance - Prescribing

Note that under current national NHS regulations a GP working under a GMS or PMS contract can only prescribe drug treatment for erectile dysfunction in the following cases:

  • A man with erectile dysfunction who on 14 September 1998 was receiving a course of treatment for this condition with any of the following drugs:

    Alprostadil (Caverject®), (MUSE®), Viridal®)

    Apomorphine Hydrochloride (Uprima®)

    Moxisylyte Hydrochloride (Erecnos®)

    Silenafil (Viagra®)

    Tadalafil (Cialis®)

    Thymoxamine Hysrochloride (Erecnos®)

  • A man who is suffering from any of the following: 

    diabetes

    multiple scelerosis

    Parkinson's disease

    poliomyelitis

    prostate cancer

    severe pelvic injury

    single gene neurological disease

    spina bifida

    spinal cord injury

  • A man who is receiving treatment for renal failure by dialysis.

  • A man who has had the following surgery:

    prostatectomy

    radical pelvic surgery

    renal failure treated by transplant

    Note that under current national NHS regulations a GP working under a GMS or PMS contract can only prescrive appliances for the treatment for erectile dysfunction in the following cases:

  • A man who is suffering from any of the following:

    diabetes

    multiple scelerosis

    Parkinson's disease

    poliomyelitis

    prostate cancer

    severe pelvic injury

    single gene neurological disease

    spina bifida

    spinal cord injury

  • A man who is receiving treatment for renal failure by dialysis

  • A man who has had the following surgery:

    prostatectomy

    radical pelvic surgery

    renal failure treated by transplant

Referral Guidance

Refer to Urology:

  • Young men who have always had difficulty in obtaining or maintaining an erection.

  • Men with a history of trauma (e.g. to genital area, pelvis, or spine)

  • If an abnormality of the penis or testicles is found on examination

  • Men who do not respond to the maximum dose of at least two phosphodiesterase-5 (PDE-%) inhibitors (for people with diabetes, consider referral to diabetes clinic) 

Refer to Endocrinology:

Those men who have hypogonadism (abnormal testosterone, follicle-stimulating hormone, luteinizing hormone or prolactin levels).

Useful Links

CKS Guidelines

Bristol Sexual Health Services