HNY Policy and Pathway Repository - Humber

This is a consultant led specialist service for men who have problems with penile erection, ejaculation both premature and delayed, loss of libido associated with sexual dysfunction, irrespective of their age or other co-morbidity.

Suspected prostatic cancer, testicular cancer, severe diabetes (newly diagnosed), pituitary tumours such as Prolactinoma, Peyronies disease without sexual dysfunction, cardiovascular disease, where sexual activity is considered unsafe, deformity of penis or testicles, primary Hypogonadism, Endocrine disorders spinal problems, liver or kidney disease, severe lower urinary tract symptoms.

Exclude Red Flag Symptoms

• ED - with no other significant medical morbidity that have not been given the maximum dose of at least two PDE-5 inhibitors (HERPC Guidelines for the Management of Erectile
• Not received the necessary tests to identify evidence of organic disease that may be the cause of their ED.
• Known evidence of organic disease that has not been assessed and/or treated, by the relevant consultant led speciality for their disease.
• Known evidence of primary psychogenic problems but have not been referred for necessary psychosexual therapy.
• Suspected of,  or  requiring  treatment  for,  cancer,  should  be  referred  directly  on  to  the appropriate cancer pathway.
• Abnormality of the penis or testicles (including Peyronies disease) who have not been assessed and/or treated by a urological consultant led team.
• A history of trauma and/or surgery to the genital area, pelvis or spine who have not been assessed and/or treated by a urological consultant led team.
• Hypogonadism, including abnormal testosterone, follicle stimulating hormone, luteinizing hormone, sex hormone binding globulin or prolactin levels who have not been assessed and/or treated by an endocrinology consultant led team.

• Severe cardiovascular disease that could make sexual activity unsafe or contraindicates PDE-5 inhibitor use who have not been assessed by a consultant led cardiology team and deemed safe to engage in sexual activity. Patients recovering from MI / CVA / cardiovascular surgery in the preceding 6 months where sexual activity is not advised.
• Young men who have always had difficulty in obtaining or maintaining an erection who have not been assessed and/or treated by a urological consultant led team.

Men without complex issues but excluding severe distress can be prescribed oral therapy for erectile dysfunction in primary care. Please refer to HERPC guidance on Management of Erectile Dysfunction in Primary Care https://www.hey.nhs.uk/wp/wp-content/uploads/2016/03/erectileDysfunction.pdf.

However they should be investigated to diagnose/exclude underlying causes such as hypogonadism,diabetes, CVD, LUTS, elevated PSA.

Premature and Delayed ejaculation can be referred following investigation.

• Uncomplicated patients with ED not responding to oral therapy.
• Patients where PDE5i are contraindicated.
• Patients with severe distress.
• Patients with premature and delayed ejaculation when no underlying cause is found.
• Erectile Dysfunction – with no other significant medical morbidity that have been given the maximum dose of at least 2 different PDE-5 inhibitors over a period of 4 months (HERPC Guidelines for the management of Erectile Dysfunction) and all necessary tests to identify evidence of organic disease that may be the cause of their Erectile dysfunction have been completed within primary care.

Referrals

1. E-Referral (ERAS system) please note this is for triage bookings only. Please forward referral through the ERAS system and inform the patient that they will be contacted by CHCP care co-ordination team.

2. Completed Healthcare Professional referral forms can be sent via email to CHCP.247111@nhs.net

Care co-ordination centre - NOTE: referrals from GP/HCP must be completed in full with the relevant requested information attached within the ERAS system. Failure to provide this will result in delay of an appointment for the patient.

HERPC guidance on the Management of Erectile Dysfunction in Primary Care. https://www.hey.nhs.uk/wp/wp-content/uploads/2016/03/erectileDysfunction.pdf

Do not refer patients with Red Flag symptoms.

Please do appropriate blood tests before referring patient to service as mentioned in Directory of Service.

Uncomplicated erectile dysfunction can be treated with PDE5 inhibitors. Please refer to HERPC guidance for the management of Erectile Dysfunction in Primary care https://www.hey.nhs.uk/wp/wp-content/uploads/2016/03/erectileDysfunction.pdf

Information to include

1. Age

2. Past and current medical history

3. Medications

4. Previous treatment for ED

5. Allergies

6. Results of base line investigations as mentioned,

7. Family history of CVD, diabetes and cancer