Diagnosing erectile dysfunction
A GP can often diagnose erectile dysfunction by talking to a man about his symptoms, lifestyle, medical history and carrying out a physical examination.
Questions asked may include:
- What medications or drugs are you currently using? This includes prescription drugs, over-the-counter drugs, herbal supplements, dietary supplements, and illegal drugs or alcohol.
- Have you had any psychological problems, such as stress, anxiety or depression?
- When did you first notice symptoms of ED?
- What are the frequency, quality and duration of any erections you have had?
- What are the specifics of the circumstances under which ED first occurred?
- Do/did you experience erections at night or during the morning?
- What sexual techniques do you use?
- Are there problems in your current relationship?
- Do you have more than one sexual partner?
- If you have more than one partner, do you experience ED with all of them?
The doctor may also wish to interview your sexual partner, since your partner may be able to offer insight about the underlying causes.
Erectile dysfunction tests
After a physical examination and discussion the doctor may then arrange any of the following tests:
- Full blood count (FBC): This is a blood test that, among other things, can detect the presence of anaemia. Anaemia is caused by a low red blood cell count and can cause fatigue, which in turn can cause poor libido and ED.
- Liver and kidney function tests: These blood tests may indicate whether ED may be due to your kidneys or liver functioning improperly.
- Lipid profile: This blood test measures the level of lipids (fats), such as cholesterol. High levels may suggest atherosclerosis (narrowing of the arteries), which can affect blood circulation in the penis.
- Thyroid function test: One of the functions of the thyroid hormones is to influence the production of sex hormones. A deficiency in these hormones may contribute to or cause ED.
- Blood hormone studies: Testosterone and/or prolactin levels in the blood may be measured to see if abnormalities in either of these sex hormones are present.
- PSA test: Prostate-specific antigen (PSA) is a protein produced by cells of the prostate gland. This test measures the level of PSA in the blood and can indicate prostate enlargement, infection or cancer, which may complicate ED.
- Urinalysis: Analysis of urine can provide information on protein and sugar levels. Abnormal measurements of these substances can indicate diabetes or kidney disease, both of which can cause ED.
Other tests that a specialist may perform include:
- Duplex ultrasound: An ultrasound uses high-frequency sound waves to take “pictures” of the body’s tissues. For people with ED, an ultrasound may be used to evaluate blood flow and check for signs of a venous leak, atherosclerosis or tissue scarring. This test is performed both while the penis is erect (usually induced by an injection of a drug that stimulates erection) and also while it is soft.
- Nocturnal penile tumescence (NPT): This test measures a man’s erectile function while he is sleeping. Normally, a man will have five or six erections while asleep. A lack of these erections may indicate that there is a problem with nerve function or circulation to the penis. The test uses a piece of perforated tape tied to the base of the penis. If an erection occurs during the night the tape will break.
- Penile biothesiometry: This test involves the use of electromagnetic vibration to determine sensitivity and nerve function. A decreased sensitivity to these vibrations may indicate nerve damage.
- Vasoactive injection: During this test, an erection is produced by injecting special solutions that cause the blood vessels to dilate (enlarge), allowing blood to enter the penis.
- Cavernosometry: During this test a special dye is injected into the penile blood vessels and monitored using a scanner to assess blood flow through the penis. It helps identify whether there are blood vessel abnormalities, blockages or leaks.
- Arteriography: This test is offered to people who are candidates for vascular reconstructive surgery. A dye is injected into the artery believed to be damaged and X-rays are taken.
- Bulbocavernosus reflex: This test evaluates nerve sensation in the penis. During the test, your doctor will squeeze the head of your penis, which should immediately cause your rectum to contract. If nerve function is abnormal, there will be a delay in response time or absence of rectal contraction.
Before you have any of these tests, your doctor will explain what is involved. If you have any questions, do not hesitate to ask your doctor.