Diagnosis of Erectile Dysfunction

Complete History

The history should be thorough, and include a complete medical history of diseases, treatments and surgery. The history should also include questions regarding the sexual and psychosocial history of the patient as well as the impact that the erectile dysfunction has on his relationship and social life.

Physical Examination

physical_exam

A basic physical exam which includes measuring weight, height and blood pressure

A basic physical examination which includes measuring weight, height and blood pressure should be done. A physical exam focussing on the relevant aspects in the patient’s history should then be performed. The medical professional should also include vascular, neurological and genital examinations. Because the majority of the causes of impotency are because of physical conditions, the doctor needs to examine the patient thoroughly to determine if medical diseases or risk factors for a medical condition are present.

 

Blood Tests

The blood tests which can be of benefit are hormone levels of Testosterone, Prolactin, Lutienizing Hormone (LH) and Follicle-Stimulating-Hormone (FSH). Other useful blood tests include fasting blood glucose, HbA1C (which is the measurement of the average glucose levels over a period of about 2 months), full blood count, cholesterol profile and thyroid functions.

Urine Analysis

A urine dipstick or culture is done to determine if infection of the urinary tract is present. Urinary tract infections may cause or worsen symptoms of erectile dysfunction.

Psychiatric Evaluation

If no risk factors for medical disease is present or a psychological cause of erectile dysfunction is suspected, the patient could benefit from seeing a psychiatrist or a clinical psychologist to help determine if his erectile dysfunction is possibly psychogenic in nature.

Special Investigations

Special Investigations are only done during certain situations and if indicated.

    penile tumescence monitor

    Penile tumescence monitor

  • Nocturnal penile tumescence monitor
  • This monitor is used to detect if the patient is having erections while he is sleeping. Normally a man will have 3-5 erections while he sleeps which occur in the REM (rapid eye movement) phase of sleep. A ring-like apparatus is placed around the penis and an electronic device monitors erection duration and intensity. This test can be performed at home or in a special lab. It is not painful. If adequate erections occur while the patient is sleeping, the cause of erectile dysfunction is probably not physical. Severe depression can stop normal erections from occurring. Although depression is thought to be psychological there is proof of measurable chemical changes which take place in the brain and body.

  • Intracavernous injection
  • The doctor can inject Papaverine or a similar drug into the base of the penis. This is called an intracavernous injection. Papaverine is a vasodilator (causes the veins to dilate) which encourages blood flow into the penis. The rigidity and duration of the erection can be measured with this injection.

  • Doppler Studies
  • A Doppler Ultrasound uses sound waves to see blood flow on a screen. A probe is placed on the penis to examine the blood flow in the vessels. Usually the patient gets a intracavernous injection to cause an erection before the study. This helps the medical professional to examine the vessels better.

  • Angiography
  • Angiography of the Pudendal artery is done after an intracavernous injection. This technique allows the erectile tissue of the penis to be studied. An image is made of the blood vessels in the penis. This technique is often used when the cause of erectile dysfunction was due to an injury from trauma.

    corpus_cavernosum

    Corpus cavernosum of the penis.
    100X magnifcation

  • Cavernosography
  • Cavernosography of the penis is a valuable diagnostic technique in erectile dysfunction. Any leakage or dysfunctions of the penile veins are made visible by this technique. A saline fluid is mixed with a contrast medium and injected into the penis with a small butterfly needle. A radiographic photograph is then taken of the penis to show the corpus cavernosum. The corpus cavernosum is the spongy erectile tissue which fills up with blood causing an erection. Abnormalities like leaking of the contrast medium out of the penis can be seen.

  • Scintigraphy
  • This technique involves the use of radionuclides to study blood flow to the penis. Arterial inflow and outflow rates can be measured during erection. Scintigraphy is still undergoing clinical trials and is not widely used to diagnose and determine the degree of erectile dysfunction.