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How is erectile dysfunction diagnosed?
Patient history
A diagnosis of erectile dysfunction is made in men who have repeated inability to achieve and/or maintain an erection for satisfactory sexual performance for at least 3 months. Candid communication between the patient and the doctor is important in establishing the diagnosis of erectile dysfunction, assessing its severity, and determining the cause. During patient interviews, doctors try to answer the following questions:
- Is the patient suffering from erectile dysfunction or from loss of libido or a disorder of ejaculation?
- Is erectile dysfunction due to psychological or physical factors? Healthy men have involuntary erections in the early morning and during REM sleep (a stage in the sleep cycle with rapid eye movements). Men with psychogenic erectile dysfunction (erectile dysfunction due to psychological factors such as stress and anxiety rather than physical factors) usually maintain these involuntary erections. Men with physical causes of erectile dysfunction (for example; atherosclerosis, smoking, and diabetes) usually do not have these involuntary erections.
- Are there physical causes of erectile dysfunction? A prior history of cigarette smoking, heart attacks, strokes, and poor circulation in the extremities suggest atherosclerosis as the cause of the erectile dysfunction. Diminished sensation of the penis and the testicles, bladder dysfunction, and decreased sweating in the lower extremities suggest diabetic nerve damage. Loss of sexual desire and drive, lack of sexual fantasies, gynecomastia (enlargement of breasts), and diminished facial hair suggest low testosterone levels.
- Is the patient taking medications that can contribute to erectile dysfunction?
Physical examination
The physical examination can reveal clues for physical causes of erectile dysfunction. For example, if the penis does not respond as expected to touching, a problem in the nervous system may be the cause. Small testicles, lack of facial hair and enlarged breasts can point to hormonal problems such as hypogonadism with low testosterone levels. A reduced flow of blood as a result of atherosclerosis can sometimes be diagnosed by finding diminished arterial pulses in the legs or listening with a stethoscope for bruits (the sound of blood flowing through narrowed arteries). Unusual characteristics of the penis itself could suggest the root of the erectile dysfunction, for example, bending of the penis during erection could be the result of Peyronie's disease.
Laboratory tests
Common laboratory tests to evaluate erectile dysfunction include:
- Urinalysis: An abnormal urinalysis may be a sign of diabetes mellitus and kidney damage
- Lipid profile: High levels of LDL cholesterol (bad cholesterol) in the blood promotes atherosclerosis.
- Blood glucose levels: Abnormally high blood glucose levels may be a sign of diabetes mellitus.
- Blood Hemoglobin A 1c: Abnormally high levels of blood hemoglobin A 1c in patients with diabetes mellitus establish that there is poor control of blood glucose levels.
- Serum creatinine: An abnormal serum creatinine may be the result of kidney damage due to diabetes.
- Total testosterone levels: Blood samples for total testosterone levels should be obtained in the early morning (before 8 am) because of wide fluctuations in the testosterone levels throughout the day. A low total testosterone level suggests hypogonadism. Measurement of bio-available testosterone may be a better measurement than total testosterone, especially in obese men and men with liver disease, but measurement of bio-available testosterone is not widely available.
- PSA levels: PSA (prostate specific antigen) blood levels and prostate examination to exclude prostate cancer is important before starting testosterone treatment since testosterone can aggravate prostate cancer.
Other tests
Monitoring erections that occur during sleep (nocturnal penile tumescence) can help distinguish between erectile dysfunction of psychological and physical causes. If nocturnal erections do not occur, then the cause of erectile dysfunction is likely to be physical rather than psychological, however, tests of nocturnal erections are not completely reliable. Scientists have not standardized the tests and have not determined in whom they should be done.
Psychosocial examination
A psychosocial examination using an interview and questionnaire may reveal psychological factors contributing to erectile dysfunction. The sexual partner also may be interviewed to determine expectations and perceptions encountered during sexual intercourse.
MALE SEXUAL MEDICATIONS
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Most popular men's sexual health products directory about
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The drugs used to treat erectile disfunction are
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Cialis, commonly mispelled as Cialas, Cialix,
Cyalis, Cailis,
Cealis
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Levitra,
commonly mispelled as Lavetra, Lavitra,
Levetra, Livetra,
Livitra
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Viagra, commonly mispelled as Vagara,
Viagara, Viagera,
Viegra, Vigara
The sexual supplements used to boost sexual desire and penis sixe are
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