This is the partial or complete failure to achieve a satisfactory erection. The inability to ejaculate (ejaculatory erectile dysfunction) is not dealt with here. Erectile dysfunction presents fairly often to GPs and will probably do so increasingly frequently as new treatments are developed and publicised.
This is an uncommon presentation – but one we may see increasingly frequently as men become less reticent about coming to the doctor. As with any symptom involving leakage of blood, anxiety levels tend to run high. This shouldn’t transfer to the GP, though – it is unusual for the symptom to have a sinister cause.
This term is taken to apply to women. It causes much misery and may be embarrassing for a woman to discuss with her doctor. As a result, it may be the ‘hidden agenda’, presenting as a nonexistent ‘discharge’ or vague ‘soreness down below’. Alternatively, it may be the underlying cause of a presentation of infertility or stress. Tact and sensitivity are the most valuable diagnostic and therapeutic tools in these situations.
Pain in the penis occurs not just as a result of local causes, but also by referral from remote lesions. It frequently generates embarrassment for the patient, who may also be frightened that he has a sexually transmitted disease. The diagnosis will often be clear after a carefully taken history and appropriate examination.
Presentation of this symptom is nearly always accompanied by fear of sexually transmitted disease, even in elderly or no longer sexually active men. There are a number of other causes, many of which are significant and require investigation.
Scrotal swellings can occur at any age. They arise most commonly from the testicle and its coverings, the spermatic cord and the skin. Greater awareness of testicular cancer has resulted in increasing numbers of young men attending the GP, usually with benign lumps.
This is an uncommon symptom in everyday general practice. Though commonest in the young adult, it can affect all age groups. In its acute form, it is excruciating and disabling. In the chronic form it is usually described as a dull ache or dragging sensation. It is the former which causes the GP the most diagnostic difficulty and anxiety.
Vaginal discharge is usually a symptom of the reproductive years, but can occur at any age. It can be influenced by the menstrual cycle, use of ‘the pill’, age, pregnancy and sexual activity. Treatment is often simple, but if it fails, or if there are risk factors for STDs, it is sensible to refer to a GUM clinic.
Vulval irritation encompasses soreness and itch and is a very common presentation in primary care. Embarrassment may mean a ‘calling card’ symptom has first to be presented. Sometimes it is a ‘calling card’ itself, being easier to talk about than a psychosexual problem. With sensitivity, the real issues should emerge during the consultation.
Vulval swellings may originate in the vulva, or appear there after displacement from their origin. They often present as ‘a lump down below’ – an expression which belies the variety of possible causes. They generate a lot of anxiety but are rarely sinister.
This often unpleasant symptom is uncommon, but very important, as many causes are significant and require specialist investigation, treatment and follow-up. Patients often have difficulty visualising or describing these types of lesions, so adequate examination is vital in establishing the diagnosis.