A patient attends his surgery for review of the investigation of erectile dysfunction. he is 5 5years old fit and muscular landscape gardener who is well known to his GP. Three years ago he was successfully treated for a depressive episode with a 6 month course of antidepressants medication. He describes his relationship with his wife as close and loving. They always liked to be physically intimate and used to have a regular sex life. Over the last two years he has noticed his erectile becoming less strong and more recently he has experienced erectile failure.
On examination he finds normal external genitalia, with adequate sized testicls.
a) What is the differential diagnosis
b) What are the next steps in management
c) Which tests did the GP initiate that were not indicated by patient initial presentation
d) What further tests might the GP have reasonably ordered..
e) What would you tell this patient.