Erectile Dysfunction Treatment Online

What is erectile dysfunction?

Erectile dysfunction (ED) is the persistent inability to achieve or maintain an erection sufficient for satisfactory sexual activity. It is a common condition that affects approximately one in five Australian men over the age of 40, with prevalence increasing with age. ED can have a significant impact on confidence, quality of life, and relationships.

ED can have physical causes, psychological causes, or both. Many men feel uncomfortable raising the topic face-to-face; a confidential bulk billed telehealth consultation is often the fastest and most private way to start. In many cases, ED is treatable once the underlying cause is identified.

Symptoms of erectile dysfunction

Symptoms can develop gradually or appear suddenly. Common features include:

• Difficulty achieving an erection at the start of sexual activity
• Difficulty maintaining an erection during sexual activity
• Reduced firmness or shorter-lasting erections
• Reduced sexual desire or interest
• Associated distress, anxiety about performance, or avoidance of intimacy

Occasional difficulty achieving an erection is common and not usually ED. Persistent difficulty for more than a few weeks, or difficulty that is affecting your confidence or relationship, is worth a GP assessment.

What causes erectile dysfunction?

ED is usually caused by a combination of physical and psychological factors. In men over 40, vascular causes are most common; in younger men, psychological factors tend to play a larger role. Common contributors include:

• Cardiovascular. Reduced blood flow from narrowed arteries, high blood pressure, high cholesterol, or previous heart disease.
• Diabetes. Affects both nerves and blood vessels supplying the penis.
• Hormonal. Low testosterone, thyroid disease, or other endocrine conditions.
• Medications. Some blood pressure medicines, antidepressants, and others can cause or worsen ED. Your GP can review whether an alternative is appropriate.
• Lifestyle. Smoking, excessive alcohol, illicit drug use, obesity, and physical inactivity all reduce vascular and hormonal health.
• Psychological. Stress, performance anxiety, depression, and relationship difficulties can cause ED on their own and commonly coexist with physical causes.
• Neurological or post-surgical. Nerve damage, pelvic surgery (for example prostate cancer treatment), or spinal injury.

Identifying the likely contributors is the first step in treatment. Your GP will take a history, review medications, and screen for cardiovascular risk factors during the consultation.

When to see a doctor about erectile dysfunction

Book a GP (in person or via bulk billed telehealth) if:

• You have persistent difficulty for more than a few weeks
• The issue is causing distress or affecting your relationship
• You have noticed a gradual decline in sexual function
• You also have chest pain, breathlessness on exertion, or other cardiovascular symptoms
• You have diabetes, high blood pressure, or a family history of heart disease

It is important not to ignore ED. It can be an early indicator of underlying health conditions, and many cases are treatable once those are addressed.

How a telehealth GP can help with erectile dysfunction

Many men find it easier to discuss ED in the privacy of a telehealth consultation than face-to-face. Initial assessment is based on history and cardiovascular risk rather than physical examination, so telehealth is well-suited. During the consult, your GP can:

• Send an eScript for an appropriate ED medication directly to your phone where clinically indicated
• Issue a pathology referral to screen for diabetes, cholesterol, testosterone, and thyroid function
• Refer you to a specialist such as a urologist, endocrinologist, or cardiologist if needed
• Create a Mental Health Treatment Plan and refer you to a psychologist if psychological factors are contributing
• Review your current medications for potential contributors and propose alternatives
• Discuss lifestyle changes and follow up on your progress

For eligible Medicare cardholders, the consultation and all of the above are bulk billed with no out-of-pocket cost. All conversations are confidential.

Risk factors for erectile dysfunction

Factors that raise the likelihood of ED include:

• Age (more common over 40, increases further with each decade)
• Cardiovascular disease, high blood pressure, high cholesterol
• Type 2 diabetes
• Obesity and physical inactivity
• Smoking and heavy alcohol use
• Some medications, including certain blood pressure and antidepressant classes
• Depression, anxiety, chronic stress, and relationship difficulties
• Prostate surgery, pelvic radiation, or neurological conditions

Several of these are modifiable. Addressing cardiovascular risk factors often improves erectile function as well as overall health.

ED medications: Viagra, Cialis, Levitra, Spedra

Australian Therapeutic Guidelines recommend phosphodiesterase type 5 (PDE5) inhibitors as first-line oral treatment for ED in men without contraindications. The four PDE5 inhibitors available in Australia are:

• Sildenafil (Viagra) 25–100 mg — taken 30–60 minutes before sexual activity, effect lasts approximately 4 hours. Generic sildenafil is widely available and inexpensive. Take on an empty stomach for best effect.
• Tadalafil (Cialis) 10–20 mg as needed, or 2.5–5 mg daily — the longest-acting PDE5 inhibitor, lasts up to 36 hours. Daily low-dose option provides spontaneity. Less affected by food than sildenafil.
• Vardenafil (Levitra) 10–20 mg — taken 25–60 minutes before sex, effect lasts 4–5 hours. Alternative when sildenafil is poorly tolerated.
• Avanafil (Spedra) 50–200 mg — fastest-onset PDE5 inhibitor (effect from 15–30 minutes). Useful when shorter onset is preferred.

Critical contraindication: all PDE5 inhibitors are contraindicated with nitrate medications (such as GTN sprays or isosorbide for angina) because the combination can cause life-threatening drops in blood pressure. Caution is also needed with alpha- blockers (used for BPH or blood pressure) and certain other medications. Your telehealth GP will review your full medication list, blood pressure, and cardiovascular history before prescribing.

Other treatment options

When oral PDE5 inhibitors are insufficient or not appropriate, several second-line options are available — typically via a urology referral:

• Intracavernosal injection therapy (alprostadil) — direct injection into the penis, very effective; requires training in administration.
• Intraurethral alprostadil — pellet inserted via the urethra.
• Vacuum erection devices — non-pharmacological option, particularly useful after prostate surgery.
• Penile implant surgery — for severe, treatment-resistant cases.
• Testosterone replacement therapy — only where hypogonadism is confirmed on morning total testosterone and LH; specialist input is often involved.

A combined approach often works best — oral medication alongside addressing cardiovascular risk factors, mental health support, and lifestyle changes. Your GP will help weigh the options.

When to seek further investigation

ED can sometimes serve as an early warning sign of cardiovascular disease. The blood vessels supplying the penis are smaller than those supplying the heart, which means reduced blood flow may become apparent as ED before other cardiovascular symptoms develop. Your GP may recommend investigating your heart health as part of an ED assessment, particularly if you have other risk factors such as high blood pressure, diabetes, or a family history of heart disease.

Your GP may recommend blood tests to check for underlying causes, including tests for testosterone, blood sugar, lipids, and thyroid function. Identifying and managing these factors early may help improve both erectile function and overall health.

In some cases, your GP may recommend a specialist referral. A urologist may be appropriate if there are structural or urological factors contributing to ED, while an endocrinologist may help if hormonal imbalances are identified. Your online GP can arrange these referrals as part of your treatment plan.

Psychological support can also be an important part of managing ED. If stress, anxiety, depression, or relationship difficulties are contributing factors, your GP may suggest a Mental Health Treatment Plan and a referral to a psychologist.

How to book

Visit NewDoc bulk billed telehealth to book a confidential consultation. Eligibility is checked automatically, same-day appointments are available seven days a week, and for eligible Medicare patients, there is no out-of-pocket cost for the consult, any eScript, or any referral issued during the appointment.