Diagnosing erectile dysfunction (ED) involves a comprehensive assessment by a healthcare provider to determine the underlying cause.
There are several oral medications approved to treat erectile dysfunction (ED). These pills, known as phosphodiesterase type 5 (PDE5) inhibitors, work by enhancing the effects of nitric oxide, a natural chemical the body produces to relax the muscles in the penis. This increases blood flow, making it easier to achieve and maintain an erection in response to sexual stimulation. Some common medications include Sildenafil (Viagra), Tadalafil (Cialis), and Vardenafil (Levitra, Staxyn) are good treatment for ED. Sildenafil (Viagra) Starts working within 30–60 minutes; effective for 4–6 hours, Tadalafil (Cialis) Takes effect in 30 minutes; lasts up to 36 hours (“the weekend pill”).
The evaluation typically includes a combination of medical history, physical examination, and diagnostic tests. Here’s what you can expect:
It depends on what your healthcare provider suspects is causing erectile dysfunction. Your provider may order:
- Blood tests.
- Complete blood count (CBC).
- Lipid panel.
- Liver function tests.
- Kidney function tests.
- Thyroid tests.
- Testosterone test.
- Urinalysis (urine test).
- Penile Doppler ultrasound.
- Tests that measure if the nerves in your penis respond to vibrations (penile biothesiometry).
- Drugs that temporarily make your penis erect (vasoactive injection).
- Magnetic resonance angiogram (MRA).
Before testing, your provider will explain what’s involved with a test and answer any questions you have. If you don’t feel comfortable, you can decide not to do the test at any time.
1. Medical and Sexual History
The doctor will ask about:
- Erection problems: Onset, frequency, duration, and severity.
- Sexual history: Libido (sex drive), ability to achieve or maintain erections, and any issues with orgasm or ejaculation.
- Medical conditions: Diabetes, high blood pressure, heart disease, neurological disorders, or hormonal imbalances.
- Medications: Any prescription or over-the-counter drugs you’re taking.
- Lifestyle factors: Smoking, alcohol consumption, drug use, and exercise habits.
- Psychological factors: Stress, anxiety, depression, or relationship issues.
2. Physical Examination
- Penis and testicles: Examined for abnormalities like plaques (Peyronie’s disease) or testicular size.
- Pulses: To check blood flow to the genitals.
- Secondary sexual characteristics: Signs of low testosterone, such as reduced body hair or breast enlargement (gynecomastia).
3. Blood and Urine Tests
These tests can help identify underlying medical causes:
- Hormonal tests:
- Testosterone levels.
- Prolactin (if hypogonadism is suspected).
- Blood sugar: To screen for diabetes.
- Lipid profile: To check cholesterol levels.
- Kidney and liver function tests: To rule out organ dysfunction.
- Thyroid function tests: To detect thyroid-related issues.
- Complete blood count (CBC): To check for anemia.
4. Specialized Tests
If initial evaluations suggest a specific issue, additional tests may include:
a. Nocturnal Penile Tumescence (NPT) Test
- Purpose: Measures nighttime erections to differentiate between physical and psychological causes.
- How it works: A device worn overnight records the number and quality of erections.
b. Penile Doppler Ultrasound
- Purpose: Assesses blood flow in the penile arteries and veins.
- Procedure: A small probe is used, often with an injection of medication to induce an erection.
c. Intracavernosal Injection Test
- Purpose: Tests the physical ability to achieve an erection.
- Procedure: A vasodilator drug is injected into the penis to induce an erection.
d. Dynamic Infusion Cavernosometry and Cavernosography (DICC)
- Purpose: Evaluates blood pressure in the penis and detects venous leaks.
- Procedure: A dye is injected, and X-rays or imaging capture the blood flow.
e. Psychological Assessment
- Purpose: Identifies stress, anxiety, depression, or relationship issues contributing to ED.
- Procedure: Conducted via questionnaires or counseling sessions.
5. Additional Tests
Depending on individual risk factors:
- Cardiac Evaluation: ED can be an early sign of cardiovascular disease.
- Neurological Tests: To check for nerve damage in cases of diabetes or spinal cord injuries.