Erectile dysfunction (impotence)


Advice: Consider referral only for treatable genital abnormalities (considered causative) and for patients in whom oral therapy is ineffective, contraindicated or associated with severe side-effects.
Refer To: Carol Edmunds, Nurse Consultant, Urology Department, Hinchingbrooke Hospital


Management in primary care

The majority of patients with erectile dysfunction can now be managed in general practice. Inital management involves:

  1. Exclude treatable, physical causes (e.g. hormone abnormalities, genital abnormalities); this does not require urological referral
  2. Treat modifiable factors (e.g. lifestyle, relationship problems, drugs, smoking, alcohol)
  3. Initiate oral therapy (with Sildenafil 50mg, Tadalafil 10mg or Vardenafil 10mg) provided there is no contra-indication to treatment. Treatment with the newer agents (Tadalafil & Vardenafil) should be instituted as an alternate day regime for a minimum period of 4 weeks

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Management of other abnormalities

Patients with psychosexual problems should be referred to a Psychosexual Counselling Clinic. Please note this is not offered at Addenbrookes Hospital.

Patients with hormonal abnormalities (e.g. low testosterone) should be referred to the endocrinologists

Testosterone supplements are only indicated on the advice of an endocrinologist when the serum testosterone level is low. Administration of testosterone to patients with normal serum levels is inappropriate and can promote the development of prostate cancer, sleep apnoea, polycythaemia, hepatic dysfunction and peripheral oedema.

Therapeutic options include testosterone injections (Nebido®), Andropatches or Testogel®; careful, regular monitoring of serum testosterone levels during treatment is recommended

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Urological referral

Referral is only appropriate for those in whom oral treatment is contra-indicated, not tolerated or ineffective. Referral should be made to Carol Edmunds, Nurse Consultant, Urology Department, Hinchingbrooke Hospital.

The following modalities are available in the Erectile Dysfunction Clinic:

  • Self-injection of the penis with Prostaglandin E1 (Alprostadil)
  • MUSE (medicated urethral system for erection)
  • Vacuum erection assistance devices
  • Venous leak surgery (rarely indicated)
  • Angioplasty for large vessel disease


  1. Do not refer patients who are simply curious to know the underlying cause for their condition or patients who do not actually wish to have any treatment.
  2. Penile prosthesis insertion is not available at Addenbrooke’s and requires referral either to The Institute of Urology in London or to the Norfolk & Norwich University Hospital.

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Special information

This page contains guidelines and advice from professional bodies, together with information about the prescription of drugs. Since all NHS hospitals have local arrangements with their Primary Care Trusts (PCTs) about which medicines can be used, some drugs mentioned cannot be prescribed by local hospitals.

Treatment of patients will be planned with the Consultant responsible for care, taking into account those drugs which are or are not available at the local hospital and what is appropriate for optimum patient care.

Healthcare professionals are advised to check prescribing arrangements with their local hospital or PCT.

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