New-onset sexual dysfunction in men: cardiometabolic associations and a practical outpatient approach

New-onset sexual dysfunction in men, particularly erectile dysfunction, should not be regarded merely as an isolated sexual complaint. It may represent an early manifestation of endothelial dysfunction, atherosclerotic disease, diabetes mellitus type 2, obesity, arterial hypertension, dyslipidemia, hypogonadism, hyperprolactinemia, thyroid disorders, or adverse drug effects. The aim of this review is to summarize current evidence on the relationship between sexual dysfunction and cardiometabolic risk and to provide a practical outpatient approach for primary care, internal medicine, diabetology, urology, and sexual medicine. This narrative review is based mainly on the current European Association of Urology recommendations, the Princeton IV Consensus, and selected systematic reviews and meta-analyses. Particular attention is paid to focused history taking, physical examination, basic laboratory work-up, risk stratification, and the differential diagnosis of vasculogenic, endocrine, iatrogenic, and psychogenic causes. The review also incorporates the Czech clinical context and proposes a pragmatic referral framework for situations requiring further evaluation or specialist care.