Explain erectile treatment safety and PE options — CASC communication station · Psych CASC / OSCE

Prompt

A 45-year-old man wants 'the blue pill' after seeing online adverts. He has diet-controlled diabetes, takes no nitrates, and also describes lifelong PE with severe embarrassment. Partner is waiting outside. Explain assessment priorities, PDE5 inhibitor expectations and safety, PE behavioural options, and a collaborative plan without shame.

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the outpatient clinic. [2]

Candidate instructions. Take a focused, non-judgemental sexual history outline, explain that ED and PE can coexist and that ED should be addressed carefully, counsel on PDE5 inhibitor use (stimulation required, timing, no nitrates, side-effects), introduce behavioural PE techniques and possible medication options for PE, offer partner involvement with consent, and agree follow-up including diabetes review. [1][2][3]

Candidate scenario

Man is ashamed, uses humour to deflect, has tried alcohol "to relax" before sex, and bought unregulated tablets online once. No chest pain currently; no nitrate medicines. Lifelong PE; recent erectile inconsistency with partner. Partner supportive but frustrated. [3]

Marking domains

Privacy, permission, non-stigmatising language
Phase mapping (erection vs ejaculation timing)
PDE5 efficacy framing with realistic expectations and nitrate warning even if he is currently nitrate-free (future cardiac drugs)
Correct use: sexual stimulation needed; alcohol undermines response
PE behavioural options; mention medical options exist where appropriate
Diabetes as medical risk marker — GP optimisation, not pill-only care
Offer couple involvement; safety-net chest pain/priapism; teach-back [1][2][3][4]

Reveal assessor key

Open. Thank him for raising a difficult topic; normalise sexual health as medical care. Set confidentiality frame. [2]

Map problems. "It sounds like two related issues: keeping an erection firm enough, and climax happening sooner than you want. We treat those as medical and psychological problems, not as a character flaw." [3]

PDE5 education. Explain tablets like sildenafil help many men by improving the natural erection pathway when there is sexual stimulation; they are not automatic arousal. Warn: never combine with nitrate chest-pain sprays/tablets; seek urgent help for chest pain or an erection lasting many hours. Avoid unregulated online drugs. [1][2]

PE education. Behavioural methods (pause-squeeze/stop-start) and couple techniques help; medicines can be considered if needed. If both ED and PE are present, improving erection often helps the rushing pattern. [3]

Medical context. Diabetes matters for blood vessels and nerves — GP review of sugars, heart risk, and lifestyle sits alongside any tablet. Mention IIEF-style questionnaires may track progress. [2][4]

Close. Summarise plan, offer partner session with consent, written safety points, follow-up, teach-back. [2]

References

[1]Goldstein I, Lue TF, Padma-Nathan H, et al. Oral sildenafil in the treatment of erectile dysfunction. Sildenafil Study Group N Engl J Med, 1998.PMID 9580646
[2]Burnett AL, Nehra A, Breau RH, et al. Erectile Dysfunction: AUA Guideline J Urol, 2018.PMID 29746858
[3]Althof SE, McMahon CG, Waldinger MD, et al. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE) J Sex Med, 2014.PMID 24848686
[4]Rosen RC, Riley A, Wagner G, et al. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction Urology, 1997.PMID 9187685

Station brief

Format. Communication station, approximately 7–10 minutes active time after reading. You are the psychiatry registrar in the outpatient clinic. [2]

Marking domains

Privacy, permission, non-stigmatising language

Phase mapping (erection vs ejaculation timing)

PDE5 efficacy framing with realistic expectations and nitrate warning even if he is currently nitrate-free (future cardiac drugs)

Correct use: sexual stimulation needed; alcohol undermines response

PE behavioural options; mention medical options exist where appropriate

Diabetes as medical risk marker — GP optimisation, not pill-only care

Offer couple involvement; safety-net chest pain/priapism; teach-back [1][2][3][4]

Reveal assessor key

Open. Thank him for raising a difficult topic; normalise sexual health as medical care. Set confidentiality frame. [2]

Close. Summarise plan, offer partner session with consent, written safety points, follow-up, teach-back. [2]

References

[1]Goldstein I, Lue TF, Padma-Nathan H, et al. Oral sildenafil in the treatment of erectile dysfunction. Sildenafil Study Group N Engl J Med, 1998.PMID 9580646
[2]Burnett AL, Nehra A, Breau RH, et al. Erectile Dysfunction: AUA Guideline J Urol, 2018.PMID 29746858
[3]Althof SE, McMahon CG, Waldinger MD, et al. An update of the International Society of Sexual Medicine's guidelines for the diagnosis and treatment of premature ejaculation (PE) J Sex Med, 2014.PMID 24848686
[4]Rosen RC, Riley A, Wagner G, et al. The international index of erectile function (IIEF): a multidimensional scale for assessment of erectile dysfunction Urology, 1997.PMID 9187685