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

Erectile dysfunction (ED) is a common but often underdiagnosed and undertreated condition. It affects 20% to 57.8% of men, with prevalence increasing with age. Despite established guidelines, inconsistencies in assessment and management persist in primary care.

To assess whether primary care ED management aligns with guidelines or reveals gaps causing underdiagnosis and undertreatment.

Comprehensive literature search was conducted in PubMed, MEDLINE, TRIP, and Google Scholar for studies published between January 2001 and December 2024. Search terms included: ED, primary care, family physician, practice patterns, barriers, and management. Inclusion criteria were: studies focusing on primary healthcare providers' practice patterns in the assessment and management of ED; studies examining barriers faced by primary care providers; and studies involving specialized care if findings were transferable to primary care. Review articles, case reports and very small case series (<10 participants) were excluded. Data were extracted on participant characteristics, management strategies, practitioner attitudes, comfort levels, and barriers to care. Methodological quality was assessed using critical appraisal principles.

Eleven studies met criteria: Seven cross-sectional surveys, two qualitative focus groups and two referral audits. Active discussion of ED occurred in 10% to 38% of encounters. Key barriers included limited training, time constraints, embarrassment, and unclear clinical roles. Standardized tools/questionnaires were under-utilized. Referral audits showed 26% to 37% of patients could have been managed in primary care. Evidence demonstrated low confidence, knowledge gaps and inconsistent adherence to guidelines.

ED is common but often under-assessed and under-managed in primary care. Studies show limited proactive patient-provider communication, inconsistent diagnostic approaches, poor adherence to guidelines, and frequent premature referrals. Failure to initiate discussions about ED further contributes to underdiagnosis and delayed recognition of related conditions such as cardiovascular and metabolic diseases.