Which diagnosis best fits duration, episodicity, and exclusions?
A
Erectile dysfunction
≥1 of 3 symptoms on almost all occasions (≥75–100%) of sexual activity: marked difficulty attaining an erection; marked difficulty maintaining an erection until completion of sexual activity; marked decrease in erectile rigidity
AA. ≥1 of 3 symptoms on almost all occasions (≥75–100%) of sexual activity: marked difficulty attaining an erection; marked difficulty maintaining an erection until completion of sexual activity; marked decrease in erectile rigidity B. Symptoms persist ≥6 months C. Causes marked distress
BA. Abnormal and prolonged contraction of muscles of eyes, face, neck, limbs, or trunk developing in association with medication use B. Symptoms developed within a few days of starting or raising dose of medication, or reducing medication used to treat extrapyramidal symptoms
Common specifiers
ALifelong; Acquired; Generalised; Situational
BMild; Moderate; Severe; With oculogyric crisis
Differential flags
AVascular cause - atherosclerosis, hypertension (most common physical cause; assess CV risk); Hormonal cause - hypogonadism, hyperprolactinaemia (check testosterone, LH, FSH, prolactin); Neurological cause - DM neuropathy, MS, spinal cord injury
BTardive dystonia (develops after months/years of antipsychotic use; persists after cessation); Primary torsion dystonia (genetic; no medication link); NMS (hyperthermia + rigidity + autonomic instability - systemic features distinguish)