Erectile Dysfunction

Diagnosis

Diagnosis Erectile Dysfunction

Erectile dysfunction (ED) is a problem that needs to be diagnosed correctly to find what causes it, so that you get the appropriate treatment.

Discussing ED with your family doctor or urologist may be uncomfortable, but it is important to do so. Together you can discuss which treatment is right for you.

This section lists the different tests your doctor may need to assess your situation. It offers general information about diagnosis of ED. Keep in mind that situations can vary in different countries.

Medical history

Your doctor will take a medical history to understand your general state of health. As part of the medical history your doctor will ask about any other conditions you may have.

Your doctor may ask you:

  • If you take any medication
  • If you smoke
  • When and how much you drink
  • If you drink much coffee or alcohol
  • If you use recreational drugs on a regular basis
  • If you ever had pelvic surgery
  • If you have any heart problems
  • If you have hormonal disorders
  • If you have any psychological problems

Sexual history

Your doctor will also ask you questions about your sex life, which could be very personal but are necessary for proper diagnosis and treatment.

Some of the questions could be:

  • The status of your previous sexual relationships
  • Your current sexual relationships
  • Your current emotional state
  • When the erectile problems started
  • How long have the erectile problems lasted
  • If you have seen another doctor specifically for ED
  • If you have received treatment for ED before

Your doctor will ask you to describe the firmness and duration of your morning erections, and sexually stimulated ones. The doctor will also ask if you have problems with arousal, ejaculation, and orgasm.

If you have a sexual partner, it may be useful to attend this consultation together.

Questionnaires

Your doctor may ask you to fill out questionnaires, which are used to asses different aspects of your sexual health. The most common are:

  • The International Index for Erectile Function (IIEF)
  • The Sexual Health Inventory for Men (SHIM)
  • The International Prostate Symptom Score (IPSS)
  • The Clinical Depression Questionnaire

Physical examination

The doctor will perform a complete physical examination, to check for abnormalities in the penisscrotum, and testicles. To check for heart disease the doctor will take your blood pressure, measure your heart rate, and order a blood test to check your level of cholesterol. Your doctor will do a digital rectal examination  to feel the size, shape, and consistency of the prostate, and if necessary check the level of prostate specific antigen (PSA) in your blood. To check for diabetes the doctor may order a test to measure the level of glucose in your blood. It could also be necessary to assess your testosterone level. This is also done with a blood test.

Cardiac risk evaluation

Because of the relation between ED and heart disease the doctor generally does a cardiac risk evaluation as part of the diagnosis. Your doctor may refer you to a cardiologist for further evaluation and specific cardiac tests, such as a ‘stress test.’

Other tests

In some cases it may be necessary to do other tests. These may include:

  • A nocturnal penile tumescence and rigidity (NPTR) test
  • An intracavernous injection test
  • Contrast-enhanced x-ray to check your blood vessels
  • Medical imaging of the penis

These are not common tests during initial diagnosis of ED and are only necessary if your doctor needs additional information to assess your personal situation.

If necessary, your doctor may refer you to a neurologist, a psychiatrist, an andrologist, or an endocrinologist for further tests.

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