Erectile dysfunction — KFP-style written assessment

KFP 1 (10 marks)

A 49-year-old solicitor attends after his partner insisted. Six months of gradual ED; morning erections still present most days but intercourse fails. Smokes 15/day, BMI 31, no regular doctor. His father had a bypass at 58.^{[6] [10]}

1. Outline your assessment, including why this presentation demands more than an ED prescription. (4) ^{[6] [10]}
2. His bloods return: total cholesterol 6.8 mmol/L, HbA1c 5.9%, BP 148/92. How do these findings integrate? (3) ^{[10] [1]}
3. He wants 'the blue tablet' immediately. What lifestyle prescriptions accompany it? (3) ^{[8] [15]}

Model answers

1. Take the sexual history properly (onset, morning erections — preserved here, situational pattern), score IIEF-5, review medications and alcohol, screen depression, then assess cardiovascular risk formally. ED is a vascular warning sign: incident ED carried HR 1.25 (CI 1.02-1.53) for subsequent cardiovascular events, and prevalent or incident ED together HR 1.45 (CI 1.25-1.69); meta-analysis gives RR 1.62 for myocardial infarction, highest at younger ages — he is exactly that man. His father's premature bypass strengthens the case. ^{[6] [10]}
2. The cluster (dyslipidaemia, borderline glycaemia, hypertension, obesity, smoking) is the same risk-factor bundle driving both his ED and future coronary events; MMAS showed impotence correlating directly with heart disease, hypertension and diabetes independent of age. Manage it as early vascular disease: formal absolute-risk calculation, lipid modification, BP treatment, smoking cessation — not just symptomatic therapy. ^{[10] [1]}
3. Lifestyle change is evidence-based ED treatment, not an add-on: six randomised trials showed lifestyle interventions plus CV-risk pharmacotherapy improved IIEF-5 by weighted mean 2.66 points (CI 1.86-3.47). Smoking cessation specifically raised total IIEF within six months across age subgroups. Frame both as treatments for erections AND arteries, prescribed alongside sildenafil rather than instead of it. ^{[8] [15]}