Erectile dysfunction
A symptom worth taking seriously
Erectile dysfunction is frequently the first sign of a cardiovascular or metabolic problem, sometimes years ahead of anything else. Treating it without looking for that is the part most services skip. Here it is the point of the consultation.
Fully online. Video consultation with Dr Qurbain, medication dispensed to your door, and no need to travel anywhere.
Want it dealt with, without the awkward bit?
If any of these sound familiar, this consultation was built for you.
You have been putting off asking anyone.
You want it treated, and you want to know why it is happening.
You would rather a doctor checked your heart than just wrote a prescription.
You want a conversation that is matter-of-fact.
This is a cardiovascular assessment that happens to treat a sexual symptom.
The blood vessels involved in an erection are small, and they are affected early. That is why ED often precedes a cardiovascular event by several years. New ED in a man under 60 is a reason to look at his heart, his blood pressure, his glucose and his lipids rather than simply write a prescription.
So every consultation includes a full cardiovascular and metabolic assessment, with blood pressure from your own validated monitor, shown to the doctor on camera — that is mandatory before anything is prescribed. If that assessment turns up undiagnosed diabetes, hypertension or raised cholesterol, that finding is the most valuable thing you take away from the appointment.
How it works
Four steps, all from home
Scored, and characterised
A validated questionnaire scores severity. Then the questions that separate a physical cause from a psychological one: how it started, whether morning erections still happen, whether it varies by situation, libido, and what is going on in your life and your relationship.
Cardiovascular risk, properly assessed
Smoking, blood pressure, diabetes, lipids, family history, exercise tolerance. A blood pressure reading from a validated home monitor, shown on camera, is mandatory. A cardiovascular risk score is recorded where the inputs allow.
Blood tests
HbA1c, fasting lipids, morning testosterone, kidney and liver function, thyroid where indicated, and PSA where your age or symptoms call for it. Read by the doctor before any prescription.
Treatment and the cause
Where treatment is appropriate it is prescribed with full counselling. Alongside it, always and on the record, we go through the modifiable risk factors, review any medicines that may be contributing, and acknowledge any psychological or relationship factors, with onward referral offered.
The first question, and it is absolute
Taken together with a nitrate, this class of medicine causes a catastrophic drop in blood pressure. There is no dose that makes it safe.
Do you take a nitrate in any form — heart tablets, a chest spray used occasionally, nicorandil, or amyl nitrite “poppers”?
If you do
Never prescribed, in any form, at any dose. You are referred instead, and told why. If any other clinician starts a nitrate later, you must tell us so treatment stops.
If you do not
Assessment continues — cardiovascular risk, blood pressure shown on camera, and blood tests, all before any prescription.
What treatment involves
Medication
- A licensed oral treatment from the PDE5 inhibitor class, taken when you need it, with the dose adjusted to response
- A daily low-dose option where activity is frequent, or where you also have urinary symptoms it can help
- Quantities limited to your expected frequency of use, and never beyond the next review
Alongside it, always
- Smoking, weight, alcohol, activity, blood pressure and glucose control addressed
- Contributing medicines reviewed, in discussion with your GP where a change is needed
- Psychosexual referral offered where that is the main issue
- Hormone treatment where a genuine deficiency is confirmed, managed under the men’s health pathway rather than this one
What you are told, in writing
- The underlying cause still needs managing — medication treats the symptom
- Any new diagnosis found is referred to your GP as the main finding of the consultation
- Do not buy these medicines from unregulated websites; counterfeits are common and dangerous
What to expect, and what it does not fix
This class of medicine works well for most men, and the dose is adjusted at four weeks against how you actually got on. It needs arousal to work — it does not create desire. Alcohol reduces its effect and increases the drop in blood pressure. And it treats the symptom: if the assessment found raised glucose, high blood pressure or a lipid problem, those still need managing, and that is where the real benefit to your health sits.
What you need to know before starting
Side effects, and what to do about them
Read
Three of these are emergencies, and you need to know them before you take the first dose rather than after.
- Never with nitrates. Not heart tablets, not a spray used occasionally, not nicorandil, not amyl nitrite “poppers”. The combination causes a catastrophic drop in blood pressure. You are asked about every one of these specifically, and if any other clinician starts a nitrate you must tell us.
- An erection lasting more than four hours is a medical emergency — attend A&E immediately. Delay causes permanent damage.
- Sudden loss or reduction of vision, or sudden hearing loss or ringing — stop the medicine and seek urgent medical attention.
- Headache, flushing, indigestion, blocked nose and a blue tinge to vision are common and not dangerous.
- If you take an alpha-blocker for your prostate or blood pressure, the starting dose and timing are adjusted — there is a risk of feeling faint on standing.
- Your GP is always told, and specifically asked to record it, so that nitrates are avoided. For this service that notification is treated as essential to safe care.
When we will not prescribe
Who this service cannot treat, and why
Read
Some of these are absolute. Others mean a cardiologist or urologist should see you first, and you will be referred and told why.
- Any nitrate, nicorandil or similar medicine — absolute, in every form
- Heart attack, stroke or a life-threatening arrhythmia in the last six months
- Unstable angina, or angina that comes on during sex — urgent assessment
- Resting blood pressure too low, or uncontrolled high blood pressure
- Exercise tolerance too limited for sexual activity — cardiology assessment first
- A previous episode of sudden ischaemic optic neuropathy, or an inherited retinal disorder
- Severe liver impairment
- Previous priapism, or sickle cell disease or trait
- Under 40 with physical features — referred to urology or endocrinology, because ED in a young man more often signals significant underlying disease
- Penile curvature, pain or a palpable plaque — referred to urology
- Sudden onset after pelvic or perineal injury or surgery — referred
- Declining the cardiovascular assessment or the blood tests
- Alongside recreational drug use, particularly amyl nitrite
- Any sign the medicine is wanted for someone else, or for resale
Injectable treatments, vacuum devices needing fitting, and unlicensed agents are not provided — those are referred to urology or a specialist service.
Reviewed, with your blood pressure every time
The full review and monitoring schedule
Read
At four weeks: whether it worked, dose adjustment, side effects, and blood pressure. At three months: response, your cardiovascular risk factors revisited, and any outstanding referrals chased. Then every six months, with blood pressure at each review and bloods annually. Supply never exceeds the interval to the next review.
Three things that mean stop and get help
Worth knowing before you take the first dose rather than after. Everything else on the side effect list is uncomfortable rather than dangerous.
4 hours
An erection that will not subside
A medical emergency. Attend A&E immediately — delay causes permanent damage.
Stop
Sudden vision or hearing loss
Sudden loss or reduction of vision, or sudden hearing loss or ringing. Stop the medicine and seek urgent medical attention.
Never
With a nitrate
In any form, including a spray used occasionally and recreational amyl nitrite.
Our approach follows current national guidance. See the guidelines we work to.
Initial consultation
Your initial consultation is paid when you book, before the consultation, and is charged whether or not treatment is prescribed. A follow-up review is paid when it happens, and only if you or your doctor decide you need one.
Joining the waiting list is free. Medicine, if prescribed, is bought separately from the dispensing pharmacy and its cost is confirmed with you before you pay for each supply.
Video consultation, validated scoring, full cardiovascular and metabolic risk assessment, blood panel reviewed by the doctor, and a written plan including any onward referral. Medication, where prescribed, is dispensed separately by a registered pharmacy and priced before you pay.