Sexual dysfunction in cardiovascular diseaseBMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d4437 (Published 26 July 2011) Cite this as: BMJ 2011;343:d4437
- Deborah Morrison, GP academic fellow1,
- Michael Aitchison, consultant urologist2,
- Derek T Connelly, consultant cardiologist3,
- Frances S Mair, professor of primary care research1
- 1Academic Unit of General Practice and Primary Care, Institute of Health and WellBeing, University of Glasgow, Glasgow, UK
- 2Gartnavel General Hospital, Glasgow
- 3Glasgow Royal Infirmary and Golden Jubilee National Hospital, Glasgow
- Correspondence to: F Mair
- Accepted 8 July 2011
A 53 year old man attends for a routine check-up. He underwent coronary artery bypass grafting after a myocardial infarction earlier in the year, and seems to be making good progress. He says he needs to discuss an embarrassing problem. He explains that he has been having erectile dysfunction, which is making him miserable and preventing normal marital relations.
What you should cover
Clarify what the patient means by erectile dysfunction. A physical cause is more likely with gradual onset, constant erectile dysfunction with partial or poorly sustained erections, and no full early morning erections.
Check duration of the problem—is it entirely new or worsening of a pre-existing problem?
Review psychological factors such as performance anxiety, anxiety about precipitating another coronary event, low mood, stress, and relationship concerns.
Ascertain patient’s main concerns or worries.
Exclude features of hypogonadism such as loss of libido, loss of body hair, hot flushes, low energy levels, gynaecomastica, and small testicular size.
Review current medications, focusing on those that might cause erectile dysfunction (for example, β blockers, thiazides, spironolactone, fibrates, cimetidine, antidepressants, antipsychotics), or drugs that would contraindicate phosphodiesterase type 5 (PDE5) inhibitors (such as nitrates and nicorandil). Consider any temporal association with onset of erectile dysfunction symptoms.
Review risk …