Diagnosing Erectile Dysfunction

What to Expect During Your Doctor Visit

  • Men are frequently reluctant to discuss their sexual problems, particularly erectile dysfunction or ED, and often need to be specifically asked.
  • You can assist and initiate this process just by telling your doctor directly that erectile dysfunction is a problem for you. Opening a dialogue allows your doctor to begin the investigation or refer you to a consultant.
  • Scheduling enough time with your doctor to conduct a full interview and physical examination is important.
  • After performing a full interview, physical examination, and laboratory testing, your doctor can then discuss your particular situation, the most likely cause, and reasonable treatment options.

Sexual, Medical, and Psychosocial History to Diagnose Erectile Dysfunction

The first step in the medical management of erectile dysfunction is taking a thorough sexual, medical, and psychosocial history. This is a delicate topic, and your doctor should be sensitive and caring to make you comfortable about sharing these intimate details of your private life.

While conducting a full interview, specific questions like these will probably be asked:

  • Your doctor will ask if you have difficulty obtaining an erection, if the erection is suitable for penetration, if the erection can be maintained until the partner has achieved orgasm, if ejaculation occurs, if you have lost interest in sex (libido), and if both partners have sexual satisfaction.
  • You will be asked about current medications you are taking, about any surgery you may have had, and about other disorders (eg, history of trauma, prior prostate surgery, radiation therapy).
  • The doctor will want to know all medications you have taken during the past year, including all vitamins and other dietary supplements.
  • Tell the doctor about your tobacco use, alcohol intake, and caffeine intake, as well as any illicit drug use.
  • Your doctor will be looking for indications of depression. You will be asked about libido (sexual desire), problems and tension in your sexual relationship, insomnia, lethargy, moodiness, nervousness, anxiety, and unusual stress from work or at home.
  • You will be asked about your relationship with your sexual partner. Does your partner know you are seeking help for this problem? If so, does your partner approve? Is this a major issue between you? Is your partner willing to participate with you in the treatment process?

Your doctor will also want your candid answers to questions like these:

  • Your doctor will ask if you have difficulty obtaining an erection, if the erection is suitable for penetration, if the erection can be maintained until the partner has achieved orgasm, if ejaculation occurs, if you have lost interest in sex (libido), and if both partners have sexual satisfaction.
  • You will be asked about current medications you are taking, about any surgery you may have had, and about other disorders (eg, history of trauma, prior prostate surgery, radiation therapy).
  • The doctor will want to know all medications you have taken during the past year, including all vitamins and other dietary supplements.
  • Tell the doctor about your tobacco use, alcohol intake, and caffeine intake, as well as any illicit drug use.
  • Your doctor will be looking for indications of depression. You will be asked about libido (sexual desire), problems and tension in your sexual relationship, insomnia, lethargy, moodiness, nervousness, anxiety, and unusual stress from work or at home.
  • You will be asked about your relationship with your sexual partner. Does your partner know you are seeking help for this problem? If so, does your partner approve? Is this a major issue between you? Is your partner willing to participate with you in the treatment process?

Physical Examination to Diagnose Erectile Dysfunction

A physical examination is necessary. During this examination, your doctor will pay particular attention to the genitals as well as the nervous, vascular, and urinary systems. Your blood pressure will be checked because several studies have demonstrated a connection between high blood pressure and erectile dysfunction.

The physical examination will confirm the information you gave the doctor in your medical history and may help reveal unsuspected disorders, such as diabetes, vascular disease, penile plaques (scar tissue or firm lumps under the skin of the penis), testicular problems, low male hormone production, injury or disease to the nerves of the penis, and various prostate disorders.

Imaging Studies to Diagnose Erectile Dysfunction

An ultrasound examination of your penis and testicles may be performed. The principle of ultrasound is similar to the sonar used on submarines. Sound waves are reflected back when they contact relatively dense structures, such as fibrous tissue or blood vessel walls. These reflected sound waves are then converted into pictures of the internal structures being studied.

In diagnosing the cause of erectile dysfunction, an ultrasound may be done on the lower abdomen, the pelvis, and the testicles, or it may be restricted to just the penis.

  • A duplex ultrasound is a diagnostic technique that uses painless, high frequency sound waves to measure blood flow in structures such as the penis.
  • The procedure itself is painless. It is usually performed before and after injection of a smooth muscle relaxing medication into the penis, which should significantly increase the diameter of the penile arteries.
  • A duplex ultrasound is most useful in evaluating possible penile arterial disorders. Further studies of the venous drainage system as well as arterial imaging are usually recommended if vascular reconstructive surgery is anticipated.
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