Your GP asks questions, looks at your medication and usually draws blood for blood sugar and cholesterol. A physical exam belongs to it, but is often shorter than men fear. The whole consultation rarely takes more than ten to fifteen minutes.
According to Thuisarts.nl, the patient platform of the Dutch College of General Practitioners, this is a conversation GPs are used to. For you it is a one-off. For them it is Tuesday morning.
Still, many men put it off for years. A shame, and not only because of the discomfort.
Why is postponing a bad idea?
Because an erection problem is more often an early signal than an isolated problem. Research among over 9,000 men showed that men with erection problems later developed cardiovascular disease more often than men without those complaints (Thompson, 2005).
The explanation is mechanical. The vessels in your penis are roughly 1 to 2 millimetres thick, the coronary arteries around your heart three to four times as thick. Vascular damage makes itself felt in the thin vessels first.
Put differently: your erection can raise the alarm before your heart does. That is no reason to panic, but it is a reason to mention it.
And it is common. In the Massachusetts Male Aging Study, 52 percent of men between 40 and 70 dealt with it to some degree (Feldman, 1994). Your GP has probably had this conversation several times this week already.
What exactly does the GP ask?
Your GP first tries to sort out where the problem sits. The questions cover how long it has been going on, whether it came gradually or suddenly, whether you still get a morning erection, and which medication you take. Short, targeted, and not as awkward as you expect.
The question about your morning erection is the most important of the lot. It roughly separates the physical from the situational causes.
If it works in the morning or during masturbation, context plays a bigger role. If it is gone everywhere, your doctor looks at the body sooner. What a vanished morning erection can mean, we work out separately.
What happens in the consultation?
Broadly it runs along four steps. Not every step applies to everyone.
| Step | What it involves | What it looks at |
|---|---|---|
| The conversation | Duration, course, morning erection, relationship, stress | Physical or situational |
| Medication check | Blood pressure drugs, antidepressants, prostate medication | A side effect as the cause |
| Physical exam | Blood pressure, sometimes penis and testicles, sometimes prostate | Visible abnormalities |
| Blood test | Fasting glucose, cholesterol, sometimes testosterone | Risk factors for vascular damage |
The physical exam is usually the part men dread, and usually the shortest part. A prostate exam is not standard and only happens with a reason, such as urinary complaints.
You may always say you would rather not do something. That is not a refusal of care, that is a conversation.
Which blood test does the GP do?
Usually your GP looks at your fasting glucose and your cholesterol, because diabetes and vascular damage are the best known physical causes. Testosterone joins in if you also have less drive or feel tired. Prolactin only with a specific reason.
So testosterone is not the first question, and that often surprises men.
There is a reason for it. The EMAS study among over 3,000 men found that sexual complaints only clearly related to testosterone below roughly 11 nmol/l (Wu, 2010). Above that line the number explains little. The NHG guideline on erectile dysfunction describes which physical factors play into this complaint.
Which values appear on such a hormone test is covered in male sex hormones. And the link with blood sugar we work out in diabetes and erection problems.
How do you prepare for the conversation?
Write down three things beforehand: since when it has been going on, whether your morning erection is still there, and which medication and supplements you take. Ask for a double appointment when you book. Then you do not have to mention it in the last two minutes.
That last one is my most important tip in this whole piece. The classic scenario: ten minutes about your knee, and then at the door handle "oh yes, one more thing". There is no time left for that.
Picture a man of 47 sitting down at 8:40 with "fatigue" on the agenda. He mentions the erection at 8:49. The GP then has to choose between asking further and running late. Usually the schedule wins.
Just put it in the first sentence. Seriously.
Can you already have something measured yourself?
You can, and some men like walking in informed. A blood test does not replace the consultation, but it gives you something concrete to bring. What you can have tested without a referral is set out in blood test without a referral.
If less drive plays alongside the erection, our overview on less interest in sex and your hormones is a good starting point.
The Men's Hormones panel maps your hormonal values. If you want your blood sugar and cholesterol alongside, the Complete Men's Health Panel looks at more values at once.
Take the result to your GP and open the conversation with it. That works better than waiting for it to pass on its own.
References
- Thompson IM, Tangen CM, Goodman PJ, et al. Erectile dysfunction and subsequent cardiovascular disease. JAMA. 2005;294(23):2996-3002. PMID: 16414947.
- Feldman HA, Goldstein I, Hatzichristou DG, Krane RJ, McKinlay JB. Impotence and its medical and psychosocial correlates: results of the Massachusetts Male Aging Study. J Urol. 1994;151(1):54-61. PMID: 8254833.
- Wu FC, Tajar A, Beynon JM, et al. Identification of late-onset hypogonadism in middle-aged and elderly men. N Engl J Med. 2010;363(2):123-135. PMID: 20554979.
- Thuisarts.nl. I want to discuss sexual complaints with my GP. Dutch College of General Practitioners.
- NHG guideline on erectile dysfunction (biology and risk factors). Dutch College of General Practitioners.
Disclaimer
Caliberhealth works with BIG-registered doctors who assess your blood results. This article gives general information and does not replace medical advice from your GP or specialist. A blood test is a tool, not a diagnosis on its own. With serious complaints, contact your GP, or call 112 in an emergency.
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