Impotence (ED) (cont.)
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.
Next: What erectile dysfunction treatments are available? »
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