Erectile dysfunction in primary care: practice patterns, barriers, and opportunities-narrative review

Area of Science:

• Urology
• Primary Care Medicine
• Public Health

Background:

• Erectile dysfunction (ED) is a prevalent condition affecting a significant percentage of men, with incidence rising with age.
• Despite established clinical guidelines, primary care settings exhibit inconsistencies in the assessment and management of ED.
• Underdiagnosis and undertreatment of ED remain significant challenges in primary care practice.

Purpose of the Study:

• To evaluate the alignment of primary care ED management practices with current clinical guidelines.
• To identify gaps in primary care that contribute to the underdiagnosis and undertreatment of ED.
• To understand the barriers faced by primary care providers in managing ED.

Main Methods:

• A comprehensive literature search was performed across PubMed, MEDLINE, TRIP, and Google Scholar for studies published between 2001 and 2024.
• Inclusion criteria focused on primary care practice patterns, barriers, and management of ED, excluding case reports and very small series.
• Data extraction covered participant characteristics, management strategies, provider attitudes, and barriers, with quality assessed using critical appraisal principles.

Main Results:

• Eleven studies (surveys, focus groups, audits) revealed that ED discussions occur in only 10-38% of encounters.
• Key barriers include limited provider training, time constraints, patient embarrassment, and unclear roles, leading to underutilization of standardized tools.
• Referral audits indicated 26-37% of ED cases could be managed within primary care, highlighting low confidence and guideline non-adherence.

Conclusions:

• Erectile dysfunction is commonly under-assessed and undertreated in primary care settings.
• Limited patient-provider communication, inconsistent diagnostic methods, and poor guideline adherence contribute to underdiagnosis.
• Failure to address ED proactively delays recognition of critical comorbidities like cardiovascular and metabolic diseases.