- What are some appropriate questions to ask the patient?
- What do you think could have precipitated these symptoms?
- Are you under a lot of stress lately?
- How long have you been on your blood pressure medication for, have they recently changed your blood pressure medication?
- Are you experiencing any fatigue?
- Have you had any recent trauma?
- Have you been able to ejaculate at all?
- How does that affect your life?
- Does that happen every time you are trying to have intercourse or just sometimes?
- Have you been diagnosed with low testosterone level before?
- Do you have normal erection most likely during sleep or early morning?
- Do you smoke, drink alcohol or use street drugs (Dunphy, Winland & Thomas, 2015).
- What are three differential diagnoses for the patient?
- Severe urethritis
- Benign or malignant tumor
- Penile fibrosis secondary to trauma (Dunphy et al, 2015).
- What physical examination would you perform?
- A detailed exam of the penis to rule out possible abnormality (e.g., hypospadias, Peyronie plaques).
- Palpation of the testes to check for the size or any existing mass
- The length of the penis is evaluated for hypogonadism
- Palpations of all pulses are done including the penile pulse
- Neurological exam is done to check for erectile reflex or muscle weakness
- Presence of the epidymis and vas deferens is checked (Medscape, 2017).
- What diagnostics would you include?
- Erectile dysfunction possibly secondary to hypertensive drugs
- Erectile dysfunction possibly secondary to low testosterone level
- Create an evidenced-based plan of care. Include pharmacological and non-pharmacological treatments.
Lab tests include (e.g., fasting blood glucose, A1c level, fasting lipid profile, TSH, testosterone level, PSA, CBC, NPTR test). In this particular case, the patient is possibly experiencing ED due to his hypertensive drug. Consequently, the use of the current hypertensive medication should be discontinued and the patient can be placed on a different blood pressure medication to better evaluate the cause of his erectile dysfunction. In case the patient has a low testosterone level, hormonal therapy may be initiated with medication such as the Androgel 1.62% topical spray once daily. Moreover, referral to sex therapy, marriage and couple counseling may benefit the patient and his wife. If necessary, referral to a competent urologist or pelvic surgeon must be considered for further intervention. Most importantly, patient education is warranted especially if topical hormone therapy is required; for example, patient should be careful not to expose children or women to the medication during close body contact (Dunphy et al, 2015).
Another therapy that could be considered is the intracavernosal injection (ICI) of vasoactive agents which is usually used in treating and diagnosing ED. ICI therapy is an injection of medication such as Caverject, Trimix or Quadmix administered at the base of the penis to diagnose ED or induce an erection in men with ED. In spite of its efficacy, it does have its limitations; For instance, the dropout rate for ICI therapy is considerably high due to unpleasant side effects such as priapism, ecchymosis, hematoma formation, and penile fibrosis. In addition, some men find the injections to be very painful then as a result discontinue the treatment. Consequently, in order to reduce dropout rates, patients should be thoroughly educated about the benefits and risks of ICI therapy prior to beginning treatment (Belew, Klaassen & Lewis, 2015). Overall, Sexual dysfunction is a critical public health issue in male patients and is associated with reduced quality of life. Therefore, such disorder should be treated effectively to restore and improve quality of life in men and their partners (Bacconi & Gressier, 2017).
Bacconi, L. & Gressier, F. (2017). Efficacy and tolerance of PDE-5 in the treatment of erectile dysfunction in schizophrenic patients: A literature review. Encephale Journal, 43 (1). Retrieved from https://www.ncbi.nlm.nih.gov
Belew, D., Klaassen, Z. & lewis, R. W. (2015). Intracavernosal Injection for the Diagnosis, Evaluation, and Treatment of Erectile Dysfunction: A Review. Sexual Medicine Reviews, 3 (11). Retrieved from http://onlinelibrary.wiley.com
Dunphy, L. M., Winland, J. E., Porter, B. & Thomas, D. J. (2015). Primary Care: Art and science of advanced practice nursing (4th ed.). Philadelphia, PA: FA Davis
Medscape, 2017. Erectile Dysfunction. Retrieved from https://emedicine.medscape.com