Erectile dysfunction — structured viva

Structured oral on erectile dysfunction: the vascular-disease reframe with PPCP and meta-analysis numbers, assessment discipline (IIEF, testosterone rules), PDE5 prescribing with sildenafil trial data and the nitrate contraindication, lifestyle as genuine therapy, second- and third-line escalation, and psychosexual input.

Prompt

The examiner opens: 'A healthy-looking 47-year-old asks for Viagra. He has no other diagnosis. Take me through the consultation.' The viva branches through the cardiovascular lens, assessment rigour, first-line prescribing, the non-responder pathway, escalation options, and psychosexual therapy.

Stem

You are the GP. The man in front of you wants a script, not a consultation; his arteries may want the opposite. ^[10]

References16Show

[1]Feldman HA, Goldstein I, Hatzichristou DG et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. The Journal of urology, 1994.PMID 8254833
[3]Goldstein I, Lue TF, Padma-Nathan H et al. Oral sildenafil in the treatment of erectile dysfunction. Sildenafil Study Group. The New England journal of medicine, 1998.PMID 9580646
[6]Thompson IM, Tangen CM, Goodman PJ et al. Erectile dysfunction and subsequent cardiovascular disease. JAMA, 2005.PMID 16414947
[10]Vlachopoulos CV, Terentes-Printzios DG, Ioakeimidis NK et al. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circulation. Cardiovascular quality and outcomes, 2013.PMID 23300267
[8]Gupta BP, Murad MH, Clifton MM et al. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Archives of internal medicine, 2011.PMID 21911624
[12]Corona G, Rastrelli G, Morgentaler A et al. Meta-analysis of Results of Testosterone Therapy on Sexual Function Based on International Index of Erectile Function Scores. European urology, 2017.PMID 28434676
[11]Yang M, Ni X, Sontag A et al. Nonresponders, partial responders, and complete responders to PDE5 inhibitors therapy according to IIEF criteria: validation of an anchor-based treatment responder classification. The journal of sexual medicine, 2013.PMID 24125113
[14]Duncan C, Omran GJ, Teh J et al. Erectile dysfunction: a global review of intracavernosal injectables. World journal of urology, 2019.PMID 30895359
[18]Zhang F, Luo Z, Xue Q et al. Efficacy of vacuum erectile device in refractory erectile dysfunction: a systematic review and meta-analysis. International journal of impotence research, 2026.PMID 40542251
[17]Cocci A, Capogrosso P, Minhas S et al. Penile prosthesis implantation: a systematic review of intraoperative and postoperative complications. International journal of impotence research, 2026.PMID 40514408
[7]Melnik T, Soares BG, Nasello AG The effectiveness of psychological interventions for the treatment of erectile dysfunction: systematic review and meta-analysis, including comparisons to sildenafil treatment, intracavernosal injection, and vacuum devices. The journal of sexual medicine, 2008.PMID 18564156
[5]Melnik T, Abdo CH Psychogenic erectile dysfunction: comparative study of three therapeutic approaches. Journal of sex & marital therapy, 2005.PMID 16020142
[9]Scranton RE, Goldstein I, Stecher VJ Erectile dysfunction diagnosis and treatment as a means to improve medication adherence and optimize comorbidity management. The journal of sexual medicine, 2013.PMID 23153075
[2]Rosen RC, Riley A, Wagner G et al. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology, 1997.PMID 9187685
[15]Sahin MO, Sen V, Gunduz G et al. Effect of smoking cessation on sexual functions in men aged 30 to 60 years. International braz j urol : official journal of the Brazilian Society of Urology, 2020.PMID 32374127
[19]Ergun O, Kim K, Kim MH et al. Low-intensity shockwave therapy for erectile dysfunction: An abridged Cochrane review. BJU international, 2026.PMID 41906634

Erectile dysfunction — structured viva

Stem

You are the GP. The man in front of you wants a script, not a consultation; his arteries may want the opposite. ^[10]

References16Show

[1]Feldman HA, Goldstein I, Hatzichristou DG et al. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. The Journal of urology, 1994.PMID 8254833
[3]Goldstein I, Lue TF, Padma-Nathan H et al. Oral sildenafil in the treatment of erectile dysfunction. Sildenafil Study Group. The New England journal of medicine, 1998.PMID 9580646
[6]Thompson IM, Tangen CM, Goodman PJ et al. Erectile dysfunction and subsequent cardiovascular disease. JAMA, 2005.PMID 16414947
[10]Vlachopoulos CV, Terentes-Printzios DG, Ioakeimidis NK et al. Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies. Circulation. Cardiovascular quality and outcomes, 2013.PMID 23300267
[8]Gupta BP, Murad MH, Clifton MM et al. The effect of lifestyle modification and cardiovascular risk factor reduction on erectile dysfunction: a systematic review and meta-analysis. Archives of internal medicine, 2011.PMID 21911624
[12]Corona G, Rastrelli G, Morgentaler A et al. Meta-analysis of Results of Testosterone Therapy on Sexual Function Based on International Index of Erectile Function Scores. European urology, 2017.PMID 28434676
[11]Yang M, Ni X, Sontag A et al. Nonresponders, partial responders, and complete responders to PDE5 inhibitors therapy according to IIEF criteria: validation of an anchor-based treatment responder classification. The journal of sexual medicine, 2013.PMID 24125113
[14]Duncan C, Omran GJ, Teh J et al. Erectile dysfunction: a global review of intracavernosal injectables. World journal of urology, 2019.PMID 30895359
[18]Zhang F, Luo Z, Xue Q et al. Efficacy of vacuum erectile device in refractory erectile dysfunction: a systematic review and meta-analysis. International journal of impotence research, 2026.PMID 40542251
[17]Cocci A, Capogrosso P, Minhas S et al. Penile prosthesis implantation: a systematic review of intraoperative and postoperative complications. International journal of impotence research, 2026.PMID 40514408
[7]Melnik T, Soares BG, Nasello AG The effectiveness of psychological interventions for the treatment of erectile dysfunction: systematic review and meta-analysis, including comparisons to sildenafil treatment, intracavernosal injection, and vacuum devices. The journal of sexual medicine, 2008.PMID 18564156
[5]Melnik T, Abdo CH Psychogenic erectile dysfunction: comparative study of three therapeutic approaches. Journal of sex & marital therapy, 2005.PMID 16020142
[9]Scranton RE, Goldstein I, Stecher VJ Erectile dysfunction diagnosis and treatment as a means to improve medication adherence and optimize comorbidity management. The journal of sexual medicine, 2013.PMID 23153075
[2]Rosen RC, Riley A, Wagner G et al. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology, 1997.PMID 9187685
[15]Sahin MO, Sen V, Gunduz G et al. Effect of smoking cessation on sexual functions in men aged 30 to 60 years. International braz j urol : official journal of the Brazilian Society of Urology, 2020.PMID 32374127
[19]Ergun O, Kim K, Kim MH et al. Low-intensity shockwave therapy for erectile dysfunction: An abridged Cochrane review. BJU international, 2026.PMID 41906634