Erectile Dysfunction (ED)
Screening and Diagnosis
Erectile dysfunction (ED) usually has a physical cause, such as disease, injury, or side effects of drugs. Any disorder that causes injury to the nerves or impairs blood flow in the penis has the potential to cause ED. To determine what might be causing ED, your doctor may use the following techniques and look at the following information:
A person’s medical and sexual histories help define the degree and nature of ED. The medical history can disclose diseases that lead to ED, and a simple recounting of sexual activity might identify problems with sexual desire, erection, ejaculation, or orgasm.
Use of certain prescription or illegal drugs can suggest a chemical cause because drug effects are a frequent cause of ED.
A physical examination can give clues to systemic problems. For example, if the penis is not sensitive to physical touch, a problem in the nervous system may be the cause. Abnormal secondary sex characteristics, such as unusual hair pattern or breast enlargement, can point to hormonal problems, which would mean the endocrine system is involved. The doctor might discover a circulatory problem by observing decreased pulses in the wrist or ankles. And unusual characteristics of the penis itself could suggest the source of the problem—for example, a penis that bends or curves when erect could be the result of Peyronie’s disease.
Several laboratory tests can help diagnose ED. Tests for systemic diseases include blood counts, urinalysis, lipid profile, and measurements of creatinine and liver enzymes. Measuring the amount of available testosterone in the blood can yield information about problems with the endocrine system and may explain why a patient has decreased sexual desire.
Monitoring erections that occur during sleep—nocturnal erections—can help rule out certain psychological causes of ED. Healthy men have involuntary erections during sleep. If nocturnal erections do not occur, then ED is likely to have a physical rather than a psychological cause.
A psychosocial examination, using an interview and a questionnaire, can reveal psychological factors. A man’s sexual partner may also be interviewed to determine expectations and perceptions during sexual intercourse.