When to seek emergency or specialist care

These symptoms can signal conditions where hours matter. Do not wait for a booked consultation and do not try to treat them at home.

• An erection lasting more than three to four hours, or a painful erection lasting more than an hour in a man with sickle cell disease^[1].
• Sudden, severe pain in a testicle, testicle pain with nausea, vomiting or tummy pain, or testicle pain lasting more than an hour or continuing at rest, which can mean torsion^[2].
• Chest pain or pressure during or after sexual activity, especially if it spreads to the arm, neck, jaw or back, or comes with sweating, sickness, light-headedness or breathlessness^[3].
• A cracking sound with sudden pain, swelling and loss of erection during sex, which can mean penile fracture, a urological emergency^[5].

These symptoms are not usually emergencies, but they need an examination or tests that a remote consultation cannot provide.

• Blood in the urine, even once and even without other symptoms^[7].
• Blood in the semen^[6].
• A new lump or swelling in a testicle or the scrotum^[2].
• A new bend in the penis, a hard lump in the shaft or pain with erection^[8].
• Sores, ulcers, discharge or a rash on the genitals, which need examination and tests for infection.

Erectile dysfunction shares causes with heart disease, and consensus guidance recommends that men with erectile problems have their cardiovascular risk assessed, and that men with known heart disease have their fitness for sexual activity checked before treatment^[4]. If you have erection problems together with chest pain on exertion, breathlessness, diabetes or high blood pressure, ask for that assessment in person whichever system of medicine you use.

A private consultation is suited to discussing symptoms, reviewing test results and deciding on treatment once emergencies have been excluded. If you describe any of the warning signs above during a consultation, the doctor will advise emergency or in-person care rather than treat you remotely. After that care, a follow-up consultation can help with what comes next.