What the consultation evaluates
The doctor reviews your history to distinguish sexual performance anxiety (SPA) from an organic cause such as vascular, neurogenic or hormonal erectile dysfunction. SPA is characterised by mounting sympathetic arousal — a cascade involving the hypothalamic-pituitary-adrenal axis and increased catecholamine release — that can impair the parasympathetic signalling needed for smooth-muscle relaxation in the corpora cavernosa (Pyke, Sex Med Rev 2020; PMID 31447414). A systematic history covering onset, context (partnered versus solitary), presence of nocturnal erections and concurrent anxiety or mood symptoms is the first step in separating the two. Sexual performance anxiety is one of the most prevalent sexual complaints and contributes to both psychogenic erectile dysfunction and premature ejaculation (Pyke, Sex Med Rev 2020; PMID 31447414). One objective means of distinguishing SPA from arterial ED is penile echo-colour Doppler ultrasound (PCDU) after intracavernous alprostadil. A 2021 cross-sectional study of men with non-organic ED found that those with severe anxiety (GAD-7 score ≥15) showed a distinct “late-responder” haemodynamic pattern: peak systolic velocity normalised only after 20 minutes, whereas patients with minimal-to-moderate anxiety reached normal values by 5 minutes. The degree of anxiety correlated inversely with peak systolic velocity at every measured time point (Cannarella et al., J Clin Med 2021; PMID 33494316).Your path to treatment
Because worry about performance and a physical cause of erectile difficulty can look similar day to day, the consultation is built around the same doctor review as any other sexual-health case, rather than assuming either cause up front.1
Start your online visit
Answer a questionnaire about your health and goal. No in-person appointment, no travel — you’ll know within 24 hours if you’re a candidate.
2
A doctor reviews your case
A licensed doctor reviews your answers personally. If they need clarifications, they message you in the private chat on your account. If treatment is appropriate, they sign an electronic prescription.
3
Review and payment
If the doctor does not approve treatment, the consultation fee is refunded in full within 48 hours.
4
Ongoing support
Private chat with your doctor for questions, a 4-week check-in, and renewal before your prescription expires.
If a physical cause is identified during review, see erectile dysfunction for the treatments a doctor may then consider.
How Hi-Doctor handles it
One consultation, one doctor, one decision. See pricing for the consultation fee, how it works for the full process, and safety for how doctor review works.Related reading
- Erectile dysfunction — where a physical cause is identified instead
- Sexual health consultation — the pathway this review sits in
- How a consultation works
- Safety and eligibility
Start a consultation
Sexual health consultation
Answer the sexual health questionnaire and a registered doctor reviews it.
They decide whether treatment is appropriate, which one, and at what dose —
and declining is a normal outcome. See what it costs
and how the review works.