…

[Alchemist]

Asking private Questions but totally confidential :
1- What’s exact problem do you face inn your intimate relation ship?
2-Since when it started? Sudden onset or Gradual?
3-Do you feel the mind is willing but the body is not?
4-Do you have a problem in sustaining erection?
5-Do you notice Morning Erection?
6-How do you feel inside your self?
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Based on the rapid screening, If it occurs sudden onset so mostly it’s Psychological rather than medical cause….
Management :
1- Education and counselling about the problem
2- Counselling about the importance to be compliant on HF medications for survival improvement despite the fact that may be some medications may be implicated in Erectile dysfunction (Especially Beta blockerr ) with empathy and sympathy
3-We can selectively prescribe Nebivolol rather than any other Betablocker as it’s known to improve endothelial NO system
3-Prescription of PDi (Sildenafil or Taladafil) would be helpful
4-Correct other Modifiable risk factors for atherosclerosis (Like DM, HTN , Obesity, Hyperlipidemia, Smoking)
5-Check androgen levels to exclude secondary Hypogonadism associated with Cardiac patients and if low replacement would help after Consulting Andrologist.
6-involve Psychiatrist to assess the patient mood because depression also one of important causes of ED in such patients.