Modern medicine (allopathy)

Modern medicine starts from a diagnosis: it asks what is physically or psychologically causing a symptom, because the same complaint can have very different causes. Erectile difficulty, for example, may reflect blood-vessel disease, diabetes, a medicine's side effect, low testosterone or anxiety. Treatment is then chosen for the cause, using interventions that have been compared with placebo or with other treatments in trials, and it is revised as new evidence appears.

A doctor of modern medicine in India holds an MBBS degree, often followed by a postgraduate MD or MS, and must be registered with a state medical council or the national register maintained under the National Medical Commission Act, 2019^[1]. The Commission sets training standards and professional conduct rules for the profession.

• Basic degree: MBBS.
• Postgraduate qualifications may include MD, MS or a superspecialty degree.
• Regulator: the National Medical Commission and the state medical councils.

The doctor asks about the problem itself, how long it has lasted and whether it happens in every situation, and then about general health: blood pressure, blood sugar, cholesterol, smoking, alcohol, sleep, mood and every medicine you take. Guidelines on erectile dysfunction recommend this wider assessment because erectile problems can be an early sign of cardiovascular disease^[3][4]. Depending on your case, blood tests such as glucose, lipids or morning testosterone may be advised before any treatment.

• Sexual history and the pattern of the symptom.
• Cardiovascular and metabolic risk review.
• A medicine review, including anything bought without a prescription.
• Tests only where they would change the advice.

Depending on the diagnosis, modern medicine may use lifestyle measures, psychosexual counselling, prescription medicines and, where needed, referral for procedures. Medicines are prescribed only after consultation and only when clinically appropriate.

• Erectile dysfunction: PDE5 inhibitors such as sildenafil or tadalafil, alongside treating cardiovascular risk factors.
• Premature ejaculation: behavioural techniques, and medicines such as dapoxetine or other SSRIs, or topical anaesthetics.
• Low testosterone confirmed by repeated morning tests: testosterone therapy after weighing its risks.
• Structural conditions such as varicocele, hydrocele or phimosis: referral to a urologist or surgeon.

The statements below describe the status of the evidence; they are not a promise of how any one man will respond.

Trial evidence tells us how groups of men respond on average; it does not predict the result for an individual. A PDE5 inhibitor improves the ability to get an erection in response to arousal but does not create desire, does not reverse the blood-vessel disease that often underlies erectile dysfunction, and does not replace the cardiovascular assessment that guidelines recommend^[4].

• A medicine that helps a symptom does not by itself address its cause.
• Benefit seen in trials may not carry over to men with conditions the trials excluded.

Some problems cannot be fully assessed on a video or audio call: penile curvature, lumps, swelling or suspected structural disease usually need an examination and sometimes imaging. Medicines have side effects and not every man can take them. Psychological and relationship factors often matter as much as the physical ones, and they need time and, sometimes, a counsellor.

• Physical examination is not possible on a remote call.
• Some medicines are restricted from remote prescription under the 2020 telemedicine rules^[5].

PDE5 inhibitors must not be taken with nitrate medicines, such as those used for angina, because the combination can cause a dangerous fall in blood pressure; guidelines list this as a contraindication^[3]. Men with significant heart disease need their fitness for sexual activity assessed before treatment^[4]. Always tell the doctor about every medicine and supplement you take, including products sold as herbal remedies, which can contain undeclared drugs.

• Never combine a PDE5 inhibitor with nitrates or recreational 'poppers'.
• Seek emergency care for an erection lasting more than four hours.
• Do not buy prescription medicines without a prescription.

The doctor will advise an in-person or emergency assessment when a symptom points beyond what a remote consultation can manage: chest pain during sexual activity, an erection lasting hours, sudden testicular pain, a penile injury, blood in the urine or semen, or a new lump. Structural conditions are referred to a urologist or surgeon.

The consultation is a private video or audio call with the practice's doctor of modern medicine. Under India's Telemedicine Practice Guidelines a registered practitioner prescribes only when reasonably satisfied that the information gathered is adequate^[5], so a prescription, if any, follows the consultation and never the booking. If tests or an examination are needed first, the doctor will say so.