Ben plucks up the courage to go and see his GP and discusses his impotence problem but fails to mention that he is not taking all his medications. The GP takes a thorough history and examines Ben. He explains that he would like to carry out some observations and obtain some blood tests before deciding on future management of Ben’s problem.
Note: The GP observes that Ben’s BP and pulse are above target but can see how uptight Ben is during the consultant having to discuss this very difficult problem. He advises Ben that he will contact him with the results in a few days and see him back at the surgery in a couple of weeks.
- Blood pressure – Ben’s blood pressure is 166/92. High blood pressure is defined as greater than or equal to 140/90. Ben’s blood pressure is above this and requires attention as he is known to have a diagnosis of coronary artery disease.
- Heart rate – Ben’s pulse rate is 78. Manual pulse is checked to measure number of heartbeats per minute (rate), assess if pulse is regular or not (rhythm) and identify strength (volume) of pulse.
- BMI – Ben’s BMI is 28. People with a body mass index (BMI)>30 have a 40-fold increased risk of developing diabetes and a two to three-fold increased risk of cardiovascular disease compared to individuals with a normal BMI of ≤25. Central obesity (measured by waist circumference) is a better predictor of cardiovascular risk than BMI. Central obesity is present if the waist circumference is ≥102 cm in men (≥90 cm in Asian men) and ≥88 cm in women (≥80cm in Asian women).
- U & E’s, Glucose, Lipids, Testosterone, Thyroid function, Prostate-Specific Antigen (PSA) are all routine bloods a GP would take if someone presented with impotence.
Pulse point
Where there is a strong temporal relationship between starting a drug and development of a sexual side effect, it seems more likely that there will be a causal relationship. If the patient has been on a drug for many years and the sexual problem has only recently developed, the causal relationship seems less likely.
It is important not to compromise the effective management of other important conditions when attempting to identify or resolve suspected drug-induced ED. Physicians should be aware that some men may stop medication without telling them, particularly when pack labelling indicates that it may cause ED.
Page last reviewed: 04 Jun 2020
