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.
What is the treatment for erectile dysfunction?
The treatment of erectile dysfunction depends upon the underlying cause and will be individualized by the health care professional for each patient.
If the underlying problem causing erectile dysfunction is due to low testosterone levels in the body, androgen (male hormone) replacement therapy may be indicated. These medications can be injected into a muscle, applied as a gel on the skin, or provided by a transdermal patch. Testosterone preparations taken by mouth tend not to work.
There is often a stepwise approach to treatment beginning with medications by mouth. Phosphodiesterase inhibitor medications include sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis), and avanafil (Stendra).
These medications are very effective at helping with erectile dysfunction. Your doctor will need to review your medical history and other medications you are taking to make sure they are appropriate for you.
Should these medications fail, penile injections with prostaglandins or the use of a pellet placed inside the urethra of the penis may be considered with or without the above mentioned medications by mouth.
Are there other therapies for erectile dysfunction?
Some other therapies to treat erectile dysfunction include:
- Vacuum devices are used to draw blood into the penis. Then, a constricting ring placed at the base of the penis prevents the backflow of blood.
- Two surgery options are available. The first involves the placement of semirigid rods into the penis. These bendable rods allow for placement of the penis into a position appropriate for intercourse. The second implant is an inflatable device that helps control penis size and rigidity.
- Because erectile dysfunction is relatively common and because many patients show a reluctance to have frank discussions with their health care professional, many over-the-counter medications, vitamins, supplements, and alternative therapies have been marketed directly to the consumer.
- Flaxseed, arginine, zinc, vitamin C, vitamin E, and bioflavonoids are just some of the herbal medications recommended for erectile dysfunction. None are FDA approved nor are there medical studies demonstrating their effectiveness.
- DHEA may be effective for erectile dysfunction but it is not recommended for patients whose erectile dysfunction is associated with diabetes or other nerve disorders. Its safety for human use is not certain. Herbal remedies that suggest they increase testosterone levels in the body have not yet been proven to be effective.
- Acupuncture may be an alternative therapy that has been shown to benefit patients with erectile dysfunction.
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"NIH Consensus Conference. Impotence. NIH Consensus Development Panel on Impotence." JAMA 270.1 (1993): 83-90.
Vlachopoulos, C.V., et al. "Prediction of cardiovascular events and all-cause mortality with erectile dysfunction: a systematic review and meta-analysis of cohort studies." Circulation: Cardiovascular Quality and Outcomes 6.1 (2013): 99-109.