How Is Erectile Dysfunction Diagnosed?
The diagnosis of erectile dysfunction (ED) begins with your conversation with your physician explaining the problem. It’s understandable if you feel more comfortable going into details while seeing the physician, rather than over the phone. Once you are in the physician’s office, speak up promptly. If you wait until the visit is nearly over (“By the way, Doctor, I also have…”), then your physician may find it difficult to give your diagnosis the attention it deserves.
Improved public awareness of ED as a medical condition has made more people comfortable discussing it with a physician. However, commercials and advertisements can sometimes leave unrealistic expectations. The most effective treatment for ED may or may not be a prescription; it depends on the cause.
Diagnosis is how your physician confirms that you have ED, finds out the cause and any aspects of your health that point to a particular treatment as the best one for you.
Sexual and medical history
To obtain your sexual and medical history, your physician will ask you questions. Some physicians may use a standardized questionnaire, such as the International Index of Erectile Function, as a starting point for the sexual history.
The sexual history helps make it clear how severe the ED is and what form it takes. Your physician may ask:
- How long you have noticed that you are having problems with erections, and whether the problem started abruptly or intermittently
- Whether the start of your problems with erections seems to be linked to any other event, such as an injury, new physical activity, or taking a new medication
- How often you have intercourse now and how often you had it before the problem developed
- Whether you have difficulty with vaginal penetration, or with maintaining your erection after vaginal penetration
- How firm your erection is
- Whether your erections are different (better) when you are alone, with a different partner, or with a different kind of stimulation
- Whether you have a curvature or any pain in the penis
- Whether you have any problems with desire, ejaculation or climax, and if so, whether these problems appeared at the same time as the erectile dysfunction or separately
Your medical history helps the physician understand what physical factors may be causing or contributing to the ED. Your physician may ask:
- Whether you have any illnesses, like high blood pressure, diabetes, or heart disease
- Exactly what medications you are taking
- Whether you smoke, drink or take other drugs, and how much
- Whether you’ve had previous surgery or radiation therapy in the pelvic area
- Whether you’ve had previous injuries in the pelvic area
- Whether you’ve had previous injuries to the head or spinal cord
- Whether you have problems with urination and whether you’ve been treated for it
Physical examination
Your physician will examine you for signs of illnesses or injury that could be causing or contributing to your ED. This examination may include:
- Evaluating your overall appearance (including signs that you have normal levels of male hormones)
- Performing a chest exam to check your heart and lungs
- Performing an abdominal exam to check your liver and kidneys
- Checking to make sure your pulse is strong and healthy at your wrists and ankles and in the arterial vessels at or near the groin (indicating healthy blood flow)
- Examining your testes, penis and prostate
- Performing a neurologic exam to check your reflexes, balance, coordination, and other nervous system functions
Laboratory and other diagnostic tests
Laboratory tests provide additional evidence suggesting or ruling out physical causes of ED. Your physician may not use all of the tests available today, especially if the cause of the problem becomes clear without additional testing.
Diagnostic tests that your physician can choose from in your evaluation include:
- Blood tests that screen for:
- high cholesterol and triglycerides
- high blood sugar
- kidney or liver disease
- Blood tests that screen for hormone disorders
- A blood test for prostate specific antigen (PSA) - screens for prostate disease, which may coexist with ED
- Doppler ultrasound imaging - reveals whether there is enough blood flow to and from the penis, and how well-formed the blood vessels are; this may involve an injection into the penis to cause an erection
- Other imaging tests of the penis and its blood supply
- Tests to find out if you have erections at night while sleeping
- Specialized neurologic testing to evaluate nerve function; however, not chosen routinely
- Cardiac stress testing and/or other tests of heart function, or of blood supply to the heart to screen for heart disease, if suspected by the physician