Who treats erectile dysfunction in Calgary within Alberta Health Services (AHS)?

Erectile Dysfunction Treatment in Calgary, Alberta Health Services

In Calgary, erectile dysfunction is primarily treated by urologists within Alberta Health Services (AHS), though family physicians can initiate evaluation and first-line treatments before specialist referral if needed. 1

Initial Assessment and Management

Primary care physicians are typically the first point of contact for erectile dysfunction (ED) management and can:

• Conduct initial evaluation including medical/sexual history focusing on:

  • Onset and severity of symptoms
  • Presence of nocturnal/morning erections (suggesting psychogenic components)
  • Cardiovascular risk factors 1

• Perform basic laboratory testing:

  • Morning serum total testosterone
  • Glucose/HbA1c
  • Lipid panel 1

• Initiate first-line treatments:

  • PDE5 inhibitors (sildenafil, tadalafil, vardenafil, avanafil)
  • Lifestyle modifications
  • Medication adjustments 1, 2

Specialist Referral Pathway in Calgary AHS

Referral to a urologist within AHS is appropriate when:

• First-line treatments fail
• Complex cases requiring specialized assessment
• Consideration of advanced treatments (intracavernosal injections, surgical options) 1

Calgary-specific urology referrals for ED within AHS typically go through:

1. Family physician referral to urology services
2. Centralized referral system for specialist appointments
3. Assessment at specialized men's health clinics within the AHS network

Treatment Options Available in Calgary AHS

The treatment approach follows a stepwise algorithm:

1. First-line (Primary Care):

   • PDE5 inhibitors
   • Psychosexual counseling
   • Lifestyle modifications 1, 2

2. Second-line (Specialist):

   • Intraurethral alprostadil suppositories
   • Intracavernous injection therapy
   • Vacuum constriction devices 1

3. Third-line (Specialist):

   • Penile prosthesis implantation 1, 2

Important Considerations

• Cardiovascular Assessment: ED often signals underlying cardiovascular disease, requiring risk stratification before treatment 1

• Psychogenic Components: The presence of nocturnal erections suggests psychological factors that may benefit from combined pharmacological and psychological approaches 1

• Common Pitfalls:

  • Overlooking cardiovascular risk assessment
  • Neglecting partner involvement in therapy
  • Assuming purely psychogenic or purely organic causes 1

• Medication Contraindications: PDE5 inhibitors are contraindicated with nitrate use due to risk of severe hypotension 1

Follow-up Care

Treatment effectiveness should be assessed using validated questionnaires such as the Sexual Health Inventory for Men (SHIM) or Erection Hardness Score during follow-up appointments 1.

For patients with complex needs or who don't respond to initial treatments, specialized men's health clinics within AHS provide comprehensive management options including advanced therapies and multidisciplinary care.