Diagnostic methods of ED

 
There are also some specific diagnostic methods aimed solely at the detection of erectile dysfunction.
 
These are:
 

Artificial drug-induced erection (intracavernosal injection).

intracavernosal-kit

Intracavernosal Injection Kit

It is achieved with the help of a vasoactive medicine. The main aim of this procedure is to evaluate the quality of erection, the speed of its development and its duration.

The procedure

A vasoactive medicine is injected intracavernosally in order to induce blood filling of corpora cavernosa. The procedure is supplemented with erotic visual and genital stimulation. The degree of erection is assessed using six-point rating scale ranging from the absence of any reaction to the medicine and to a good erection of the penis.

The reaction to the pharmacological load is considered positive if good erection develops during 5-10 minutes and lasts for 30-60 minutes. Delayed erection (develops in 20-25 minutes) may indicate penile arterial insufficiency, whereas the subsidence of erection indicates venous leakage.

In most cases, this test helps differentiate psychogenic erectile problems from organic erectile dysfunction and suspect this or that type of vascular disorders basing on the nature of the developed erection.
 

Nocturnal penile tumescence

erectometer

Monitoring of nocturnal spontaneous erections by means of specific computer system

Monitoring of nocturnal spontaneous erections by means of specific computer system. This method helps differentiate between psychogenic and organic erectile dysfunction as well as determine the character of erection disorder (neurogenic, vasculogenic).

This test examines male erectile function during sleep. Usually a man experiences from 5 to 6 episodes of erection during his sleep (each lasting for 20-30 minutes). The absence of spontaneous erections may indicate a problem with nervous function or blood supply to the penis.

This test includes two methods of measurement:

  • Penis circumference measurement – three plastic loops having various tension ratios are fastened around the penis. Erectile function is evaluated depending on which of the loops has been torn.
  • Penis rigidity measurement – the loops of the measuring device are tightened around the circumference of the penis at its root and at its top. If erection happens at night, the loops will stretch and the electronic device will register these changes.

 
The sensitivity of this method, as well as its specificity, is rather low and the results obtained with its help can be interpreted only in combination with the results of other tests. Since both these methods record the quality of the erection, but not the sleep quality, they cannot be used in patients with sleep disorders. Various medications as well as psychic factors (like depression) can affect nocturnal penile tumescence. The quality and rigidity of such spontaneous erections are reduced with age, also such decrease can be caused by hypogonadism (reduced activity of the sexual glands). In some systemic nervous disorders, such as multiple sclerosis, nocturnal spontaneous erections may continue, but there are no psychogenic and reflex erections, and that makes sexual intercourse impossible.

These methods are used in forensic medicine and for the study of erectile dysfunction caused by surgical intervention or trauma, especially, when an isolated injury of cavernous nerves is suspected.
 

Duplex ultrasound of the vessels in penis

Portable-ultrasound-scanner

Portable ultrasound scanner

This method is irreplaceable in the diagnosis of vasculogenic erectile dysfunction caused by dysfunction of the blood vessels in penis. During this procedure they use high-frequency waves for the visual assessment of body tissues.

Special preparations are injected into the patient’s penis with the help of a syringe. After a while, usually it takes about 10-15 minutes, when erection of a varying intensity occurs, ultrasound of the penis is performed – it visualizes penile cavernous arteries and helps evaluate the blood flow velocity in these arteries.

In patients with erectile dysfunction duplex ultrasound can be used to evaluate the state of the blood flow and detect the signs of venous leakage and atherosclerosis, as well as to assess the state of the vascular walls.

This procedure is performed twice: the first time – when the penis is erect (usually after the injection of a medicine that stimulates erection) and the second time – when it is relaxed.
 

Penile electromyography

Electromyography portable device

Electromyography portable device is used to evaluate the autonomic innervation of the penis

Electromyography is a method used for the study of muscle electrical activity. This method helps diagnose neurogenic erectile dysfunction.

Penile electromyography is currently the only method that is used to evaluate the autonomic innervation of the penis.

The procedure

They use needle and surface electrodes for this procedure. The doctor who runs the procedure leaves the room for the time of the test in order to avoid any false results that can be caused by high sympathetic tone of the patient (stresses, excitement). The recording of the electrical activity lasts for 40 minutes. But, doctors consider the results of the last 20 minutes. When detecting electrical potentials in a healthy man, penile electrical activity is registered in the form of identical curves comparable with those recorded from other smooth muscle organs.

Penile electromyography makes it possible to detect not only the fact but also the severity of the involvement of the neural structures that involved in the process of erection. In this connection, it is reasonable to use this method if there is even the slightest hint on neurogenic erectile dysfunction.
 

Biothesiometry of the penis.

Biothesiometry_Equipment

Biothesiometer uses electromagnetic vibrations to check penis innervation

This test uses electromagnetic vibrations to check penis innervation and its sensitivity.

A special device that generates electromagnetic vibrations is placed on the surface of the penis and the patient should report if he feels any vibration.
Reduced sensitivity to vibration can indicate defective innervation that may result from diabetes, neuropathy, or aging.
Increased sensitivity happens in young people and often it is the cause of premature ejaculation in teenagers.
 
 
 

Cavernosometry

 
This method involves measurement of the vascular pressure in penile cavernous bodies and helps directly assess the abnormalities in flexibility of the sinusoid system.

The procedure

This functional study involves introduction of physiological saline into the penis corpora cavernosa in order to create artificial erection. The introduction is performed at a certain speed and using a roller pump. When doing cavernosometry doctor assesses the speed with which the fluid is pumped in the penis and the time of erection. He also considers the flow rate required to maintain erection.

Cavernosometry is performed in diagnostic purposes as well as to assess the quality of the treatment of venogenic erectile dysfunction, which is associated with the excessive venous outflow from the penis or stretchability of penis cavernous bodies during erection.

This procedure is often performed in conjunction with cavernosopraphy. At first they do cavernosometry and then as its natural extension – cavernosopraphy.
 

Cavernosography

corpus-cavernosum-of-a-normal-human-penis

Corpus cavernosum of a normal human penis

It is an X-ray examination helping detect veins that are subject to pathological venous outflow in the case of vasculogenic erectile dysfunction, as well as evaluate the structure of the corpus cavernosum and find the spots of sclerosis and atrophy.

The procedure

Fluid is introduced into the cavernous bodies of the penis in order to achieve erection. Together with physiological saline they inject a small amount of X-ray contrasting agent, and after that a series of X-ray images of the erect penis is made in various projections.

Cavernosography is used mainly in diagnostically complicated cases making it possible to differentiate arterial inflow failure from venous occlusion and detect the location of the massive venous blood shunt into the arterial bed of the penis. It also allows visualization of the traumatic raptures in the penis.
 
 
All the above described methods are undoubtedly effective, each in its own case, but the most important point in the diagnosis of male sexual diseases and disorders is that diagnostic conception and strategy should always be decided by a medical specialist in a conversation with a patient and after his examination. Accurate diagnosis requires the implication of at least several methods of diagnosing.