• The Review Course in Family Medicine

GUIDELINE ALERT: New Canadian Erectile Dysfunction Guidelines


Practical Pointers and Pearls


At The Review Course, our faculty regularly conduct a systematic review of new guidelines and Family Medicine content so you can stay up-to-date.


The Canadian Urological Association released new 2021 Guidelines on Erectile Dysfunction this year – here are 3 things you need to know:


SNAP SAMP: Harry is a 56-year-old male who presents to your office requesting a medication to aid erectile function.

  1. List EIGHT risk factors for vasculogenic erectile dysfunction as listed in the 2021 CUA guidelines.

  2. Harry has all eight risk factors. Based on these 8 risk factors, what other diseases is he possibly at higher risk for? List THREE.

  3. What components of a physical exam would you recommend for Harry? (answers below)

1. History and physical exam are necessary steps that are often overlooked in primary care. See the SAMP answer for the guideline-recommended physical exam components from multiple body parts.

2. A Validated Assessment Tool doesn’t replace a good history but can help assessment and tracking whether the treatment is working. Know about the Erection Hardness Scale (EHS), Sexual Health Inventory in Men (SHIM), and the International Inventory of Erectile Function (IIEF) – the only one validated in men who have sex with men (MSM) populations.

3. Lab tests to consider: fasting glucose and lipids, HbA1C, testosterone.

4. You know the first-line treatments. Be sure you can list treatments that are second-line (intraurethral alprostadil, intercavernosal alprostadil injections also known as MUSETM : Medicated urethral system for erection, vacuum erection pump device) and third-line (penile prosthesis).


The Review Course is planning in-person events for Spring 2022; we cover all 105 topics you need to know for the CCFP exam, and all the guideline updates for 2022.

For the Erectile Dysfunction guideline we’ll highlight what’s changed since the last guideline, and what you should never write on the CCFP exam even though it’s in the CUA guidelines. See you there!

SNAP SAMP Answers:

  1. Advancing age, diabetes mellitus, dyslipidemia, hypertension, obesity, metabolic syndrome, sedentary lifestyle, and smoking.

  2. According to the CUA guidelines: “ED may serve as an early warning sign for the future development of vascular events.” Acceptable answers include anything from the Canadian Cardiovascular Society list of atherosclerotic cardiovascular diseases (ASCVD): , including acute coronary syndrome (ACS), myocardial infarction (MI), stable or unstable angina, coronary artery disease documented using angiography, coronary or other arterial revascularization (coronary artery bypass graft surgery, femoral popliteal bypass graft surgery, etc), stroke, transient ischemic attack, documented carotid disease, peripheral artery disease, and abdominal aortic aneurysm

  3. Overall: Blood pressure, body habitus, virilization, mood, gynecomastia. Penis and groins: Penile length and girth, presence of penile plaques, phimosis, frenular tether, meatal stenosis, quality of femoral pulses. Testicles: Volume and consistency.


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