Diagnosing Erectile Dysfunction

By

Marijke Vroomen Durning, RN

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A couple of decades ago, no one mentioned erectile dysfunction (ED), or impotence. Now, you see and read about it everywhere – usually in advertisements for ED drugs. It’s much more common than people may think: about 40% of men in the United States experience ED. This percentage increases to up to 70% among men who are 70 years old. The recent availability of effective ED treatments may be the reason more men are seeking help.

Of course, it’s not unusual for any man of any age to have difficulty obtaining or keeping an erection from time to time. There are many reasons why a man may be temporarily impotent, which include fatigue, stress, or physical illness. A doctor will typically diagnose a man as having ED if he can’t maintain an erection satisfactory for intercourse on at least 25% of the time. If you are experiencing ED and you’re concerned about it, it’s time to speak to your doctor. There may be a simple solution.

What can cause erectile dysfunction?

Erectile dysfunction can be caused by many issues. In some cases, ED is a symptom of an unrelated problem. The most common medical causes of ED are:

  • Heart disease (high blood pressure, atherosclerosis, etc.)

  • High cholesterol

  • Diabetes

  • Obesity

  • Neurological diseases, such as multiple sclerosis and Parkinson’s disease

  • Mental health issues, such as anxiety and depression

But ED can also be caused by other reasons, such as:

  • Excessive use of alcohol

  • Smoking

  • Certain types of medications

  • Treatments for prostate cancer or other prostate issues

  • Injury to the spinal cord or treatments that affect the spinal cord

  • Sleep disorders

How is erectile dysfunction diagnosed?

Since there are many possible causes for ED, your doctor will ask you questions about your medical history, lifestyle (such as, how much alcohol you drink, if you smoke and if you exercise), the nature of the ED (Do you have difficulty obtaining the erection, keeping it, or climaxing?), and how long the issue has persisted.

Some doctors ask their patients to complete a questionnaire called the International Index of Erectile Function. This questionnaire can help patients describe their problem more accurately than they might otherwise.

After taking your history, your doctor will do a medical examination, measuring your blood pressure, checking your neurologic system by testing your reflexes, and examining your testicles, penis, and chest. The size (abnormally small testicles and enlarged breasts) may indicate low testosterone and scarring could indicate a condition called Peyronie's disease. Your doctor will likely also check your prostate, to look for signs of benign prostate enlargement, an infection or prostate cancer.

There are several types of tests your doctor may order. In addition to a urine test, which may indicate if there is diabetes or kidney damage, there are several blood tests that could be ordered. These are the most common ones for someone with ED:

  • Lipid profile, measures cholesterol levels

  • Complete blood count (CBC), which measures hemoglobin, white blood cells, red blood cells, and more

  • Heart function (BNP or B-type Natriuretic Peptide to test for heart failure)

  • Blood glucose (sugar) levels

  • Testosterone and other hormone levels

  • Prostate specific antigen (PSA)

  • Liver enzymes

If your doctor suspects there may be a specific condition causing your ED, other tests may be ordered.

  • Psychological testing: You may be referred for psychological testing if your doctor suspects a mental health issue may be the cause.

  • Imaging: Ultrasounds are sometimes ordered for the penis and testicles, but this is not common. An ultrasound provides an image of the tissues inside the body without exposure to ionizing radiation. A wand moves along the side of the penis or testicles, sending out high frequency sound waves that bounce back when they encounter body tissue.

  • The ultrasound image allows the radiologist to see if there is anything wrong with the internal structure of the penis or testicles. A Doppler ultrasound measures the blood flow to the penis, which may provide helpful information as well.

  • Blood flow testing: The prostaglandin E1 injection test involves your doctor injecting prostaglandin into your penis to check for blood flow. If the blood flow is adequate, the prostaglandin injection should cause an erection.

  • Nocturnal penile tumescence (NPT) test: also called the overnight erection test. This is done at home. You will be provided with a monitor that will record if you have an erection while you are sleeping.

  • Neurological testing: Your doctor could also refer you for neurological testing, to check that your nervous system is working properly.

Erectile dysfunction may be an embarrassing topic to broach with your doctor, but it’s a very common problem and you are not alone. Talk to your doctor.  A thorough examination may help you find the problem and help you treat it.

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PHYSICIAN CONTRIBUTOR older male shopping for medication

Treatment Options for Erectile Dysfunction

Erectile dysfunction is an early indicator of a more serious medical condition like cardiovascular disease.  
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Medical Reviewers: William C. Lloyd III, MD, FACS Last Review Date: Apr 15, 2016

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