Erectile Dysfunction - Diagnosing

Introduction

The diagnosis of ED is fairly easy. Determining why ED is occurring, on the other hand, can be more difficult. To accurately identify why a patient is suffering from ED, a medical professional will usually conduct a comprehensive patient interview, followed by a physical examination, and possibly laboratory testing.

The interview may include the following types of questions:

• Questions relating to the specific erectile complaint
• Questions relating to medical factors that could be contributing to ED
• Questions relating to psychosocial factors that could be contributing to ED
• Questions relating to prior evaluation or treatment

Identifying ED

What tests can help identify the causes of ED?

The diagnosis of ED is easy. Determining why ED is occurring, on the other hand, can be more difficult. Identifying the cause of ED usually begins with a structured interview, followed by a physical examination, and possibly laboratory testing.

Determining whether a person suffers from ED rather than other sexual problems of ejaculation, orgasm, or sexual desire is an essential first step. Once ED is established, a doctor will determine the nature of ED. Finding the cause begins by asking many of the previous questions in order to obtain a medical, sexual and psychological history. These questions can be helpful in determining the severity of ED and revealing possible medical conditions or diseases that may be causing, or merely complicating, a man's ED. Sometimes a doctor may also ask their patient to complete a questionnaire regarding their sexual function which can confirm the presence of ED.

• After this structured interview, a physical examination is performed in order to help identify physical problems that may be causing ED. A simple physical examination often includes a check for abnormalities in the penis and testicles.
• Pulse examination - including lower extremity pulses that may indicate circulatory problems.
• Neurological examination - including gait and postural instability, testing sensations of touch, and reflexes.
• Rectal exam - checking sphincter tone and evaluating the prostate.
• Abdominal examination - looking for signs of liver or kidney disease.

Some simple laboratory tests may be performed. These tests include:

• Blood tests
  • Testosterone: Deficiency in this sex hormone can be linked to sexual dysfunctiono Blood sugar levels - screening for diabetes.
  • Lipid profiles - determines cholesterol and triglyceride levels, possibly indicating arteriosclerosis (which can reduce blood flow to the penis).
  • Liver and kidney function - disease to either the liver or kidney can create hormonal imbalances. Enzyme and serum creatinine level analysis for liver function are indicators of kidney efficiency.
  • Thyroid function - production of sex hormones and regulation of metabolism is done by thyroid hormones.
• Urinalysis - also analyzes sugar and hormone levels that may indicate diabetes, as well as kidney dysfunction and testosterone deficiency. In some men, further tests may be required in order to help identify the cause of ED. These include erectile function tests, such as:
  • Vascular testing: the most commonly performed testso Injection testing - Agents that cause increased blood flow are injected into the erectile chamber of the penis to cause an erection. The response to the medication may aid the physician in defining the cause of the problem.
  • Duplex ultrasound - Also called Doppler color-flow mapping or Doppler ultrasound - It is a form of ultrasound that allows physicians to see the structure and blood flow through blood vessels.
  • Dynamic infusion cavernosometry/cavernosography (DICC) - A sophisticated penile blood flow test conducted in some men with ED and penile abnormalities, Usually done at major medical centers or by ED experts.
• Neurological testing: these tests are rarely done these days.
  • Penile biothesiometry - Electromagnetic vibration is used to evaluate penile sensitivity and nerve function.
  • Somatosensory evoked potentials - Electrical, tactile or another type of stimulation of the nerves to determine nerve damage and function.
  • Pudendal electromyography - The pudendal nerve is the main nerve supplying the pelvis, bladder and urethra. Damage to this nerve can cause ED. Electromyography is a test that doctors use to detect nerve function and measure the electrical activity generated by muscles. Therefore this test can determine if damage to the pudendal nerve is the cause of ED.
• Nocturnal penile tumescence - Men normally have erections when asleep at night, if not, this may be indicative of a problem with nerve function, hormones or blood supply to the penis.

Diagnosing ED

How is ED diagnosed?

What questions do doctors ask when discussing ED with patients?

The kinds of questions a doctor might ask about ED are:

A. Questions relating to the specific erectile complaint:

1. How long have these symptoms been present? Did they begin gradually or suddenly?

• Your doctor needs to know if this is a new problem or one that has been ongoing for some time.

2. Do you wake up with an erection? How about in the evening?

• Men naturally have erections while they sleep and when they wake up in the morning. This is one way your doctor might determine the severity or cause of the problem.

3. If you do have erections, how firm are they? Is penetration difficult?

• The doctor needs to get a sense of how severe ED is since dissatisfaction can vary.

4. How consistent is the problem: Is penetration difficult 50%, 75% or 100% of time?

5. Do your erections change under at different times such as with different partners, oral stimulation, or masturbation?

• Does ED vary from one circumstance to another, or is it consistent throughout all sexual experiences?

6. Are there any difficulties with sexual desire (libido), arousal, ejaculation, or orgasm (climax)? If so, did these difficulties occur before or after the onset of the ED, or are they separate issues?

• It is possible that your ED is due to, or occurring in conjunction with, a different sexual dysfunction?

7.What effect is this problem having on your sexual satisfaction, your sexual confidence, or your relationship (if you are in one)?

B. Questions relating to medical factors that could be contributing to ED:

1. What medical conditions do you have?

• ED is strongly linked to a number of other common diseases in men such as: diabetes, heart disease, high blood pressure, high cholesterol, vascular disease, neurologic conditions, chronic liver or kidney disease.

2. What medications are you currently taking?

• There are a number of medications that may cause, or contribute to ED.

3. If and how much do you smoke, drink, or use other drugs?

• Certain lifestyle habits increase a man's likelihood of having ED. Alcohol or drug abuse can contribute to heart disease, hardening of the arteries and hypertension, all of which can lead to ED.

4. Is there a new curve or bend to the penis? If curvature is present, is it painful? What is the location and severity of the curvature?

• Peyronie's disease, which is an inflammatory condition that produces scarring within the penis, causing it to curve or bend, can also contribute to ED.

5. Any previous history of surgery or radiation therapy, particularly in the pelvic region?

• For example, treatments for prostate disease may also cause ED.

6. Any history of pelvic, genital, or spinal cord trauma?

• Injury to these areas can sometimes interfere with the body's ability to develop and maintain an erection.

7. Do you experience urinary problems?

• ED may also be caused by urinary tract problems, such as irritation or problems in voiding (such as urinary frequency, urgency, and dysuria [pain or burning during urination]).

C. Questions relating to psychosocial factors that could be contributing to ED:

1. How is your relationship with your partner? Has anything changed recently?

• ED can sometimes be a result of marital (or relationship) problems.

2. What is your sex life like? Has anything changed recently?

• This sometimes leads to questions about the quality of your sexual relationships and sexual intimacy, such as frequency, sexual expectations from you and your partner, or any performance anxiety that may exist.

3. In general, are you under a lot of stress? Or has anything particularly upsetting happened to you?

• Excessive stress from any aspect of life - work, relationship, financial, etc. may lead to ED

4. Have you been feeling down and depressed a lot? Do you have any psychological illnesses or have you considered seeing a psychologist?

• Depression or other mental illnesses can contribute to ED.

D. Questions relating to prior evaluation or treatment:

1. What testing have you have done to date?

2. Have you used any treatments for ED? What kind or response have you obtained? Have you been using them properly?

3. Did you experience any side effects from the medications?