Erectile Dysfunction (ED, Impotence) (cont.)

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What are the risk factors for erectile dysfunction?

Perhaps the most important risk factors that can be controlled for erectile dysfunction are those related to peripheral artery disease or hardening of the arteries. High blood pressure, high cholesterol, smoking, and poorly controlled diabetes all contribute to narrowing of arteries in the body. Not only can blood flow to the penis be affected but so can blood supply to all the major organs in the body. Erectile dysfunction is associated with coronary artery disease, stroke, and claudication (pain during exercise, especially in the legs). Drug and alcohol use are risk factors for erectile dysfunction. Repeat local trauma -- such as bicycling -- affects the nerves and blood flow to the penis which may cause erectile dysfunction.

Can young men get erectile dysfunction?

The likelihood of developing erectile dysfunction tends to increase with age and affects more than 30 million men in the United States. However, younger men can also be affected but the cause is most often psychological and related to stress or performance anxiety. Alcohol and drug abuse may also be contributing factors.

It is important to remember that erectile dysfunction shares the same risk factors as heart disease and it is appropriate to seek medical care to assess the potential for heart attack. It may be appropriate to be screened for high blood pressure, high cholesterol, and diabetes.

How is erectile dysfunction diagnosed?

Erectile dysfunction is a difficult subject for the patient to broach with their health care professional and the conversations require sensitivity and support. Because there are different causes of erectile dysfunction, the approach may be different for each patient.

Depending upon the situation, blood tests may be helpful, but they are not required for every patient. Sometimes the diagnosis can be made by history and physical examination alone.

  • If there is a loss of libido associated with erectile dysfunction, a blood test measuring morning testosterone levels might be appropriate. Testosterone levels peak in the morning.
    • If the testosterone level is low, then luteinizing hormone (LH) levels may be checked. Luteinizing hormone is a hormone in the pituitary gland of the brain that stimulates the testes to produce testosterone.
    • If luteinizing hormone is high and testosterone is low, then the problem is in the testes. The pituitary is using luteinizing hormone to signal the testes to make testosterone but it is not responding.
    • If luteinizing hormone and testosterone are both low, the problem may reside in the brain, either with the pituitary gland or hypothalamus. There is no signal for the testes to make testosterone.
  • Blood sugar, cholesterol, and kidney function blood tests may be considered.
  • Prostate-specific antigen (PSA) may be considered in the appropriate situation to test for prostate disease.
  • Urinalysis may be performed to look for infection or other abnormalities of the kidneys and bladder.
  • Ultrasound can check blood flow to the penis.
  • Other tests might include evaluation of erections during sleep. Most men get erections while they sleep.

A variety of other tests can be performed in specific circumstances to assess blood flow and skin sensation of the penis. Most often these tests are performed by urologists and are reserved for patients who are victims of trauma or who have had surgery.

Medically Reviewed by a Doctor on 3/18/2014

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