Diagnosis of Erectile Dysfunction(ED)

6 minutes

Erectile Dysfunction(ED) is one of the common sexual problems in men. Erectile Dysfunction is a condition where a man cannot achieve or maintain an erection for sexual intercourse.ED is quite common as men age and the main factor that causes this condition is the inadequate supply of blood into the penis. ED in men in the United States was accurately measured as more than 50% in those above 40 years of age and 31% in men overall.

The whole phenomenon behind erection when a man is aroused is the blood flow into the penis, when there isn’t sufficient blood flow into the penis it causes erection dysfunction and this can be caused due to various conditions which include underlying health issues such as heart disease, diabetes, hypertension, obesity, Direct nerve damage, and Peyronie’s disease.

Erectile dysfunction is being more common in younger men too due to their lifestyle habits and also due to stress. Although the probability of developing erectile dysfunction increases with age, aging itself is not a cause of ED. 

The first step in treating ED is diagnosing the condition. Most healthcare providers will ask you about your general health and your erection problem. They may also give you a physical exam and order lab tests. You may find it difficult to talk with a healthcare professional about ED. However, remember that healthy sex life is part of a healthy life. The more your doctor knows about you, the more likely he or she can help treat your condition. Here are some different ways to diagnose Erectile Dysfunction.

Physical Exam

The doctor might start with a physical exam to check your overall health. This often starts with an examination of your penis and genitals and evaluate your nerve sensation. The doctor may also perform a rectal exam to check for the prostate. A general inspection of body habitus to identify hair distribution, overweight and secondary sex characteristics is carried out.

The doctor can check for the sensitivity of the penis, in case if it lacks sensitivity then there might be a problem in the nervous system that causes Erectile dysfunction. A brief neurological examination is carried out, with the evaluation of sensation in the lower extremities, deep tendon reflexes, and perineal sensation.

This can include the test to check if there are any hormonal problems like extra hair on the body or man boobs that can lead to this condition.

These tests aren’t painful and are helpful as they can provide useful information about your condition.

Medical and Sexual History

A full medical history is critical, with special attention to risk factors and medications. A little background about your health history and lifestyle can help the doctor diagnose the issue. 

Patients are queried regarding morning erections, nocturnal erections, erectile quality, erections during masturbation, and ejaculatory function. For patients who complain of loss of libido or sexual desire, hypogonadism may be considered as a possible cause. Low libido, however, may also be caused by medications, hypochondriasis, stress, anxiety, or depression. 

Younger men more often complain of premature ejaculation, whereas those in the older age group more often have difficulties with retarded or even absent ejaculation. This may be caused by natural aging, lack of androgen, neurological abnormalities, medications, or pelvic surgery. 

Another important question is whether one has more difficulty obtaining or maintaining the erection.  Difficulty obtaining an erection implies an arterial inflow problem while difficulty maintaining an erection implies a problem with the veins called a “venous leak”.  During the erection, the veins are supposed to stop draining blood from the penis. Veins that continue to drain blood can cause ED. 

Psychological exam

Erectile dysfunction is associated with some mental health conditions. As a result, you may be asked questions by your doctor to check for depression, anxiety, or other psychological causes.

In case if you have experienced a lot of recent stress or if any major changes have happened in your life lately do tell that to the doctor as it can help the doctor diagnose the cause effectively.

If your doctor thinks there’s a psychological cause, he might refer you to a mental health professional.

Lab Tests

You will then undergo basic blood testing for ED.  These tests include fasting glucose, testosterone – total and free, and lipid profile.  These tests allow screening for underlying medical conditions including diabetes, dyslipidemia, and abnormal hormone levels.

Urine analysis

Urine research may include a variety of knowledge, including information about the levels of protein, sugar, and testosterone. Diabetes, kidney failure, or testosterone deficiency, both of which can cause ED, can be shown by irregular measurements of levels of protein, sugar, and testosterone.

Duplex Ultrasound

Duplex ultrasound is one of the best tests for evaluating ED. High-frequency sound waves are used in ultrasound to take images of the tissues of the body. An ultrasound can be used by people with ED to assess blood supply and screen for signs of venous bleeding, atherosclerosis (hardening of the arteries), or scarring of the skin. This procedure is carried out both when the penis is erect (usually caused by an erection-stimulating drug injection) and when it is soft.

Nocturnal penile tumescence test (NPT test)

Nocturnal penile tumescence test is used to measure a man’s erectile function while he is sleeping. Normally, a man will have five or six erections while asleep. A lack of these erections may indicate there is a problem with nerve function or circulation to the penis. The test uses two methods, the snap gauge method, and the strain gauge method. The snap gauge method is performed by wrapping three plastic bands of varying strength around the penis. Erectile function is then measured based on which of the three bands breaks. The strain gauge method works by placing elastic bands around the tip and base of the penis. If the penis becomes erect during the night, the bands stretch, measuring the changes in penile circumference. Patients with psychogenic ED will have normal erections during sleep while those with organic ED will not have erections during sleep.   

Dynamic infusion cavernosometry

This test is used for men with ED who have a venous leak. During this test, fluid is pumped into the penis at a predetermined rate. By measuring the rate at which fluid must be pumped to attain a rigid erection, doctors can determine the severity of the venous leak.

Bulbocavernosus reflex

Bulbacavernosus reflex test evaluates the sensation of nerves in the penis. Your doctor will squeeze the head of your penis during the test, which should instantly cause your anus to contract. There will be a delay in response time if nerve function is abnormal.