How is erectile dysfunction diagnosed?

Not all men suffer from erectile dysfunction, but if you think you do, here is how it is diagnosed.

By: Dr Ashwin Mallya | | Updated: February 25, 2015 6:23 pm

Mr Ravi Kumar is a 34-year-old software professional with a successful career. But unfortunately he is unable to have children. He has been married for 3 years now, and he and his wife Arti have delayed having kids due to their work commitments. But now the couple is ready to have children and the inability to conceive has them worried. Ravi visits his physician with complaints of poor erections from the last 1 year. Incidentally Ravi is a smoker from the last 8 years smoking about 8-10 cigarettes /day and is also on the heavier side and does not involve in regular exercise. Also Read - Prostate cancer: Bring down you risk of this condition by having several cups of coffee a day

This is typical of a lot of young professionals these days. In this article we take you through the evaluation of a patient with erectile dysfunction a condition that affects around one in five males above the age of 20 all over the world. Also Read - Erectile dysfunction can be reversed: Seek help to avoid complications

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A complete evaluation of ED will include a detailed history which includes sexual aspects, general health status and psychosocial history. So one has to be prepared to answer questions that may be seemingly uncomfortable but very necessary for a proper diagnosis. It is also important for people to understand that ED may occur due to psychogenic causes (which means that there may not be any problem physically ), organic causes (which means that there may be a physical problem), or organic (when both factors co exist). Trust your doctor who will try his/her best to put you at ease in the most non-judgemental way possible. Also on occasion a partner interview may also be done to get the complete picture and to look for any possible issues within the relationship.

The first step: A detailed history

A detailed medical history will begin with the problem itself. How long have you had it, how did it start, how has it progressed, how is your libido, etc. Information will also be sought about co-existing medical conditions like diabetes, hypertension, prostate disease, depression, previous surgeries and trauma to the genitals, etc. Also you will be asked about habits like smoking, alcohol use and other substance abuse history. Any medications or dietary supplements you may be having should also be conveyed to the physician.

The history also includes psychological aspects, which will be sought in detail. Any strains on the relationship, fears and insecurities do have a role in damaging the quality of sexual intercourse.

The second step: Physical examination

Once a detailed history is taken, your doctor will perform a physical examination, which will include a general physical examination encompassing cardiovascular and nervous systems as well as external genitalia. Your blood pressure will also be measured.

Initial investigations will include an early morning blood sample taken on an empty stomach to test for fasting blood sugar, lipid profile, complete blood profile, serum liver and kidney function tests and hormonal assessment like serum testosterone. A urine routine analysis will also be done. All these tests, put together cost around Rs 2500-3000 depending upon the lab. Based on the results of the testosterone value further evaluation including serum prolactin and Leutinizing hormone may be done. Thyroid function tests and serum PSA (prostate specific antigen) in older individuals may also be done if suspected by the physician. All these tests are available at any standard laboratory and may cost around Rs 800- 1000 each.

Following this basic evaluation more specialised investigation may be done, if necessary, as decided by the physician. These are:

Penile Duplex ultrasound: In this test the blood supply to the penis is assessed based on diameter of the arteries supplying the penis as well as flow velocities both in flaccid and erect state will be estimated. This is a non invasive, reliable method to diagnose problems in vascular (blood) supply to the penis. This may sometimes be combined with injection of a drug into the base of the penis in order to cause erections (this may be uncomfortable). Also, it is important to note that an erection subsides within an hour as prolonged erection may be a side effect of the drug. This test may cost around Rs 2000-3000

Intracavernosal Injection and stimulation: In this test a vasodilator substance is injected in to the penis and genital area or audio-visual stimulation is given to observe the erectile response. Again this involves injection of a drug hence erection has to subside within an hour or else, your doctor will administer an injection to help your erection subside.

NPTR monitoring : NPTR stands for Nocturnal Penile Tumescence and Rigidity. This test now performed using a portable device (Rigiscan) which is applied to the penis in a clinical setting and is calibrated for home use. Two loops are used one at the base and one near the tip of penis. Rigidity of penis is recorded every 3 minutes, and is increased to every 30 seconds when a diameter increase of 10mm occurs. Recommended criteria for normal measurements exist and this will be compared with normal values.

Dynamic infusion cavernosometry and cavernosography: This test is not commonly done and is performed when there is suspicion of site specific vasculogenic (leakage from the arteries supplying the penis) leak resulting from previous trauma. In this test needles are inserted in to the penis for infusion of saline and pressure measurement.

Penile angiography: This is an invasive test wherein the anatomy of the arterial supply to the penis is studies. This is especially important before planning surgery on the blood vessels to the penis.

Most of the tests mentioned above require specialised andrology (study of the male reproductive system) set-up and thus may be expensive and cumbersome. Prices and availability may vary from city to city.

Please note that invasive tests may not be required in most people as diagnosis can be done, in most patients, based on basic first line investigations along with duplex ultrasound. Also effective oral medications exist for mild to moderate ED and hence unnecessary testing may not be indicated.

Photo source: Getty images

Published : October 17, 2014 6:15 pm | Updated:February 25, 2015 6:23 pm

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