What Happens at an ED Consultation, Step by Step

Much of the reluctance to book an erectile dysfunction appointment is not embarrassment about the topic itself. It is not knowing what the appointment will involve — whether there will be an examination, what will be asked, and how much explaining will be required.

Here is the sequence, so none of it is a surprise.

Before: booking

Book a standard or long appointment depending on how much you want covered; a long consultation is worth it if you also want a general health check. You do not have to state the reason when booking, though saying mens health issue to the receptionist is enough if you prefer to signal it.

Consultations can be in person or by telehealth. Telehealth is appropriate for many initial conversations, but not where a physical examination is genuinely needed, and a responsible service will say so.

Before: preparation

Bring, or photograph:

• Every medicine you take, including over-the-counter products, supplements and herbal products.
• Any recent blood test or blood pressure results.
• A note of when symptoms started and how they behave.

Include anything you carry rather than take daily — a glyceryl trinitrate spray for angina is the classic example, and it matters enormously because nitrates are an absolute contraindication with this class of medicine.

Step one: opening the conversation

You do not need clinical vocabulary. I have been having trouble getting or keeping an erection is a complete opening. GPs hear it regularly and will take over the questioning from there.

Step two: the history

Expect questions along these lines:

• How long it has been happening, and whether it began suddenly or gradually.
• Whether it happens every time or in particular situations.
• Whether morning erections still occur.
• Whether desire is affected, and whether there is pain or curvature.
• Ejaculation and orgasm.
• Your general medical history — heart, blood pressure, diabetes, cholesterol, prostate, neurological conditions, surgery.
• Every medicine and supplement.
• Smoking, alcohol, recreational drugs, exercise, sleep and snoring.
• Mood, stress and relationship context.

These questions are diagnostic, not judgemental. Situational detail in particular helps separate likely psychological drivers from likely physical ones.

Step three: examination

Not always required, but common. It may include blood pressure, pulse, heart and chest, and abdomen. Sometimes a genital examination, and occasionally a prostate check where symptoms suggest it. Anything of that kind will be explained first and requires your consent — you can decline, ask for a chaperone, or ask for it to be done at a later visit.

Step four: tests

Frequently ordered:

• Blood glucose or HbA1c.
• Lipids.
• Kidney and liver function.
• Testosterone, usually collected in the morning.
• Sometimes thyroid function or prolactin.

Many men discover undiagnosed high blood pressure, high cholesterol or type 2 diabetes at this appointment. That is one of the most valuable things the visit does.

Step five: the discussion of options

Depending on findings, the conversation may cover:

• Treating an underlying condition such as diabetes or hypertension.
• Reviewing a current medicine that may be contributing.
• Lifestyle changes, with a review appointment later.
• Psychological support or referral where anxiety, depression or relationship factors are involved.
• Referral to a urologist, endocrinologist or psychologist.
• A medicine, if it is clinically appropriate after the assessment.

Not every consultation ends with a prescription. Sildenafil, tadalafil, vardenafil and dapoxetine are Schedule 4 prescription-only medicines in Australia requiring a valid prescription from a registered Australian prescriber, and that assessment is the reason the requirement exists. Any service that guarantees a prescription in advance is selling a product rather than providing care.

Step six: safety information

If a medicine is discussed, the prescriber should cover contraindications and cautions with you, including that nitrates are an absolute contraindication, that alpha-blockers require care, and that significant cardiovascular disease needs assessment. You should leave knowing which symptoms require urgent attention: chest pain or breathlessness during or after sexual activity, an erection lasting more than four hours, and sudden loss of vision or hearing.

Ask for the Consumer Medicine Information, and read it.

Step seven: prescriptions and dispensing

If a prescription is issued it will often be an eScript — a token sent by SMS or email that can be presented at any Australian pharmacy, in person or online. Tokens are single-use, with a new one issued for each repeat.

The pharmacist is a second checkpoint. They will check interactions against your record and answer questions, which is worth using rather than rushing past.

Step eight: follow-up

A review after a few weeks is normal, particularly if results are pending, lifestyle changes were agreed, or a medicine was started. Report anything unexpected rather than quietly abandoning the plan.

Afterwards

The appointment usually takes fifteen to thirty minutes and is far less awkward than the anticipation of it. Healthdirect Australia publishes general information if you want to read up before booking, and your pharmacist can help you assemble your medicine list beforehand.

This article is general information about what consultations involve, not medical advice. Speak with your doctor or pharmacist about your own health.