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Erectile Dysfunction
Diagnosing Erectile Dysfunction
Because
there are a variety of causes for ED, there are several different
tests your doctor may use to diagnose the condition and determine
its cause. Only after the cause of ED is determined can it
be effectively treated.
Before
ordering any tests, your doctor will review your medical history
and perform a thorough physical examination. The doctor will
also "interview" you about your personal and sexual
history. Some of these questions will be very personal and
may feel intrusive. However, it is important that you answer
these questions honestly. The 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.
Have you had any psychological problems such as stress, anxiety,
and 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?
The doctor may also wish to interview your sexual partner
since your partner may be able to offer in sight about the
underlying causes.
After
your physical examination and interview, your doctor may then
order any one of the following tests:
Complete
blood count (CBC): This is a set of blood tests that,
among other things, can detect the presence of anemia. Anemia
is caused by a low red blood cell count and can cause fatigue,
which in turn can cause 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), like cholesterol. High levels may indicate
atherosclerosis (hardening of the arteries), which can affect
blood circulation in the penis.
Thyroid function test: One of the thyroid hormones'
functions is to regulate the production of sex hormones, and
a deficiency in these hormones may contribute to or cause
ED.
Urinalysis: Analysis of urine can provide a wealth
of information, including information on protein, sugar, and
testosterone levels. Abnormal measurements of these substances
can indicate diabetes, kidney disease, or a testosterone deficiency,
all of which can cause ED.
Duplex ultrasound: This is perhaps the best test for
evaluating ED. 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, artherosclerosis 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.
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 anus
to contract. If nerve function is abnormal, there will be
a delay in response time.
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 there is a problem with nerve
function or circulation to the penis. The test uses two methods,
the snap gauge method and the strain gauge method. The snap
gauge method is performed by wrapping three plastic bands
of varying strength around the penis. Erectile function is
then measured based on which of the three bands breaks. The
strain gauge method works by placing elastic bands around
the tip and base of the penis. If the penis becomes erect
during the night, the bands stretch, measuring the changes
in penile circumference.
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.
Dynamic infusion cavernosometry: This test is used
for men with ED who have a venous leak. During this test,
fluid is pumped into the penis at a predetermined rate. By
measuring the rate at which fluid must be pumped to attain
a rigid erection, doctors can determine the severity of the
venous leak.
Cavernosography: Used in conjunction with the dynamic
infusion cavernosometry, this test involves injecting a dye
into the penis. The penis is then X-rayed so that the venous
leak can be seen.
Arteriography: This test is given 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.
Before you are given any of these tests, your doctor will
explain what is involved. If you have any questions, do not
hesitate to ask your doctor.
Reviewed
by the doctors at the Glickman Urological Institute at The
Cleveland Clinic.
Edited
by Charlotte Grayson, MD, WebMD, May 2004
Portions of this page © The Cleveland Clinic 2000-2004
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