Erectile Dysfunction Diagnosis

  • Diagnosis

    Erectile dysfunction (ED) is the inability to achieve or maintain an erection on a regular basis. Figure 01 In order to have an erection, a series of events must occur, including signals from the brain and spine to the muscles and veins of the penis. When this series of events is disrupted by physical damage, disease, drug side effects, or psychological conditions, erectile dysfunction or impotence can result. Erectile dysfunction may occur with every sexual encounter, or may occur intermittently. A man is considered to be impotent if he cannot get or maintain an erection sufficient for intercourse in 25% of attempts. Aside from the inability to get or maintain an erection, ED also may be linked to the inability to ejaculate.

    The incidence of ED increases with age. In men between the ages of 40 and 70, 25% have at least a moderate degree of ED. An estimated 30% of men have had erectile dysfuntion at some point in their lives.

    Many treatments exist for improving erectile dysfunction. Once the cause of ED is identified, medications or other treatments are available to help men have and maintain their erections. Doctors usually start with the least invasive treatment before trying the more invasive ones. First, a doctor might recommend that a patient cut back on drugs that may have erectile dysfunction as a side effect (e.g., nicotine from cigarettes; anti-depressives; and many other medications). A visit to a psychotherapist may be needed to address any psychological or emotional issues, depending on the individual situation. Other therapies such as vacuum devices, oral drugs, injected drugs, or surgery to repair damaged tissue or implant devices may be also recommended.

    Extensive diagnostic testing is usually not necessary, as effective medications are now available. The most widely known of these is sildenafil citrate (Viagra, Cialis, and Levitra), which is used by 90% of men with ED.

    Click to enlarge: Male reproductive anatomy

    Figure 01. Male reproductive anatomy

    A surgical procedure that damages blood vessels and tissues can cause erectile dysfunction. Prostate or spinal surgery may injure important nerves, blood vessels, and surrounding tissues that are important in generating or maintaining an erection. As long as at least some of these important structures remain intact, therapies can restore erectile function.

    Erectile dysfunction is more prevalent in men who take certain drugs or medications. Examples include alcohol and tobacco, or medications used to treat diabetes, depression, anxiety, high blood pressure, or heart disease. Antihistamines or antacids (specifically cimetidine) may also contribute to ED.

    Men who are regularly unable to have or maintain an erection suitable for sexual intercourse are suspected of having erectile dysfunction. Normally, aroused men receive impulses from the brain and spine that prompt the penis to fill with blood, causing an erection. If these signals are blocked, men are unable to get or maintain an erection.

    Certain diseases may make men more likely to suffer from erectile dysfunction. Some diseases can damage the blood vessels, tissues, and muscles that are involved in maintaining signals from the brain and spine to the penis. A common example is diabetes mellitus, which can damage both the nerve and blood supply to the penis. Between 35% and 50% of diabetic men have ED.

    Diseases that may cause erectile dysfunction include:

    • Diabetes
    • Kidney disease
    • Chronic alcoholism
    • Multiple sclerosis (MS)
    • Atherosclerosis
    • Heart disease

    Mental or emotional states may predispose men to ED. In 10% to 20% of cases, mental or emotional factors cause ED. Men who experience stress, anxiety, guilt, depression, low self-esteem, and/or fear of sexual failure may have erectile dysfunction. These factors usually cause impotence in younger men.

    Smoking is a risk factor of ED. Smoking may damage blood vessels. These damaged blood vessels may block signals from the brain and spine to the penis—signals that are needed for having and maintaining an erection.

    Older men may be more likely to have ED. Between the ages of 40 and 65, the incidence of ED rises from 5% to nearly 25%.

    In some cases, hormonal abnormalities such as low testosterone can predispose men to ED. In general, men with testosterone deficiency, even if it is severe, are still able to get and maintain erections. However, their nighttime erections are likely to be reduced in both frequency and intensity. Nevertheless, unless there is a contraindication, testosterone replacement therapy is always offered to men with low testosterone levels.

    Your physician will conduct a complete physical examination and sexual history. The sexual history, although personal, will indicate the onset of the dysfunction as well as the frequency, quality, and duration of any erections. The physical examination will indicate whether or not there are prostate or penis abnormalities or any medical conditions that may be causing the problem.

    You may need to undergo some tests to evaluate your condition. Table 01 In most cases, a complete physical examination and blood tests are all that is necessary, and can usually be arranged by your primary care physician. The blood tests evaluate your cell counts, blood sugar, kidney/liver function, thyroid hormone, and testosterone levels. A referral to a urologist and additional testing is limited to those people who do not respond to medication or have a history of penile injury or scarring that may require surgical intervention.

    Table 1.  Tests Available to Evaluate Erection

    Test Description
    Physical examination Looks at any abnormalities (e.g., swelling, cysts) in testicles and surrounding areas
    Digital rectal examination Checks the tone of the rectum and anus, the prostate, and rectal or anal lesions and tumors
    Blood Measures hormones, blood cells, and enzymes and identifies infections

    Tell your doctor about any medications you are taking, as some may cause ED. Usually, limiting or replacing those medications that are known to cause erectile dysfunction may minimize the problem.

    Seek prompt treatment if you suspect that you have a disease that may be contributing to ED. In some cases, ED may be the first symptom of another disease such as diabetes or heart disease. Certain diseases may cause damage to muscles, blood vessels, and tissues in the body that are involved in having or maintaining an erection. This damage may block a signal traveling from the brain and spine to the penis, which could make a man unable to have or maintain an erection suitable for sexual intercourse.

  • Prevention and Screening

    Tell your doctor about any medications you are taking, as some may cause ED. Usually, limiting or replacing those medications that are known to cause erectile dysfunction may minimize the problem.

    Seek prompt treatment if you suspect that you have a disease that may be contributing to ED. In some cases, ED may be the first symptom of another disease such as diabetes or heart disease. Certain diseases may cause damage to muscles, blood vessels, and tissues in the body that are involved in having or maintaining an erection. This damage may block a signal traveling from the brain and spine to the penis, which could make a man unable to have or maintain an erection suitable for sexual intercourse.

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