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Erectile Dysfunction / Diagnosis:

Some brief information from a doctor

In general
Causes
Treatments

Detailed information in laymen terms

Overview
Causes
Treatment

Impotence/erectile dysfunction has a stigma associated to it that prevents many men from seeking advice. They feel embarrassed even bringing it up with their doctor let alone family or friends. It is for this reason that so many men suffer needlessly. However awareness and understanding from health professionals is vastly improved today. Rarely is the word impotence used today with the term erectile dysfunction preferred.

Your family doctor is the first point of consultation about erectile dysfunction. However during the process of diagnosis there may be a number of specialists that you will be advised to consult with:

Urologists

These specialists treat diseases of the genitals and urinary tract. They specialize in disorders of the kidneys, bladder, prostate, penis and urethra. They most commonly treat impotence/erectile dysfunction especially in patients that have suspected physical causes. Urologists can perform tests to evaluate the nerves, arteries and veins that control the erection process. They may also prescribe medication and perform surgery should it be determined as the best course of action.

Not all urologists treat impotence/erectile dysfunction. Make sure that any urologist you wish to consult does work in this field.

Psychologists and psychiatrists

These specialists treat psychological causes of impotence/erectile dysfunction such as depression or anxiety.

Endocrinologists

An endocrinologist may be consulted if it is determined that your impotence/erectile dysfunction is due to testosterone deficiency, a thyroid disorder or a hormonal problem.

The following are topics that the doctor will in all likeliness ask to discuss at the first point of consultation:

• general health

• erections - whether or not the patient wakes up with an erection in the morning and the strength of the erection compared with the past

• medication – any medication the patient may be taking

• lifestyle changes – any lifestyle changes that may be affecting you sex life

• a basic medical examination

• a urologist (a physician who specializes in disorders of the kidneys, bladder, prostate, penis and urethra) may give the patient a complete physical examination. (see below)

The examination by the urologist will aim to establish if the patient's hormone levels are normal and if the blood vessels, nerves and tissues of his penis are working properly. Part of this test will try to establish how the circulation is functioning. The penis and scrotum will also be examined. A blood test may be conducted.

A medical examination may indicate a number of causes: neurological, vascular, hormonal disease or Peyronie's disease. The doctor will also review the patient's medical history.

If this initial examination does not locate the cause of the problem further tests can be done.

Establishing impotence/erectile dysfunction - testing methods

Healthy men have erections during sleep. If a patient is suffering from impotence/erectile dysfunction he may spend a few nights in a sleep laboratory undergoing tests where a gauge that measures the frequency and duration of erections is attached to the base of the penis. This is called the Nocturnal Penile Tumescence test. There is also a home use version of this test. It is called the snap-gauge test. Before going to sleep, the patient attaches the gauge to the base of his penis. During the night, the gauge will break at different degrees of penile rigidity and show whether a partial or full erection has taken place during sleep. If the patient is not getting erections in his sleep then the cause is likely to be physical.

Erectile Function Tests

Tests that assess erectile function examine the blood vessels, nerves, muscles, and other tissues of the penis and pelvic region.

Urinalysis

Urine is analyzed for protein (albumin), sugar (glucose), and hormone (testosterone) levels. This may indicate diabetes mellitus, kidney dysfunction or testosterone deficiency.

Blood Tests

A blood test may reveal any one of a number of conditions that may be a cause of impotence/erectile dysfunction. These tests measure hormone levels, cholesterol, blood sugar, liver and kidney function and thyroid function.

Establishing your levels of testosterone is also important. Excess prolactin can lower testosterone levels which in turn can lower libido. If the tests reveal anything suspect an endocrinologist should be consulted.

Complete Blood Count

A complete blood count of red and white cells is used to evaluate the presence of anemia. The symptoms of anemia are fatigue and general malaise. The level of blood lipids (fats) such as cholesterol and triglycerides may indicate arteriosclerosis. This can reduce blood flow to the penis.

Liver and kidney function tests

Liver and kidney diseases can create horomonal imbalances. The blood tests for liver function involve the analysis of enzyme and serum creatinine levels. These indicate kidney efficiency.

Thyroid function tests

Thyroid hormones regulate your metabolism and the production of sex hormones. If you have a deficiency it may be contributing to impotence/erectile dysfunction.

Duplex ultrasound tests

Duplex ultrasound is used to evaluate blood flow, whether you have a venous leak, signs of artherosclerosis and scarring or calcification of erectile tissue. Prostaglandin is injected. It is a hormone-like stimulator produced in the body. This induces an erection. Ultrasound is then used to look at vascular dilation and to measure penile blood pressure. Measurements are then compared to those taken when the penis is flaccid.

Prostate examination tests

Tests will be conducted to see if your prostate is enlarged. This can be done by a digital rectal examination. An enlarged prostate can interfere with blood flow and nerve impulses in the penis.

Penile biothesiometry test

Electromagnetic vibration is used to evaluate sensitivity and nerve function in the glands and shaft of the penis. A lack of sensitivity to this vibration may indicate nerve damage in the pelvic area. This can cause impotence.

Vasoactive injection test

When injected into the penis, certain solutions can cause an erection by dilating blood vessels in erectile tissue. These erections are not long lasting. During this procedure, penile pressure is measured and x-rays may be taken of the penile blood vessels using a special dye (contrast agent).

Penile nerve function test Tests such as the bulbocavernosus reflex test are used to determine the levels of nerve sensation in the penis. The physician squeezes the glans (head) of the penis. This should cause the anus to contract immediately if nerve function is normal. The physician measures the latency between the squeeze and contraction by either observing the anal sphincter or by inserting a gloved finger past the anus. Nerve tests such as this are used in patients with suspected nerve damage as a result of diabetes or nerve disease.

For Further Information

Diagnosis
Causes
Treatment
How an erection Occurs
FAQ's

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