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[6] [10] You should arrange a GP appointment if you experience: Persistent difficulty achieving or maintaining erections sufficient for sexual activity Sudden onset of erectile problems, especially if accompanied by other symptoms Reduced libido or changes in sexual desire Pain during erection or intercourse Concerns about fertility or reproductive health Psychological distress related to sexual function Your GP will conduct a thorough assessment including medical history, medication review, and examination

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22,23 In patients with a normal or low-normal serum vitamin B 12 level, complete blood count results demonstrating macrocytosis, or suspected clinical manifestations, a serum methylmalonic acid level is an appropriate next step 1,2,6,18 and is a more direct measure of vitamin B 12 's physiologic activity