Determining the cause of erection problems is often the key to reversing them. It can be complicated to make an exact diagnosis, since both physical and psychological factors are often involved.
As part of the initial evaluation, your doctor may do the following:
- History taking. They should ask you about your lifestyle, diet, habits (smoking, alcohol, recreational drugs), whether you have sufficient exercise and rest. You may be asked how much stress you have, what medications you take, and details regarding your sex life. This will enable them to review risk factors for erectile dysfunction.
- A complete physical exam including measurements of vital signs, chest, heart, abdomen and genitalia. A rectal and prostate exam may be necessary. Special attention will be focused on the penis and its nerve supply.
Abnormal secondary sex characteristics such as loss of armpit or pubic hair, can suggest problems in the endocrine system affecting hormone levels.
A circulatory problem might be indicated by, for example, an aneurysm in the abdomen (such as disease of the large artery, the aorta, which supplies blood to the abdomen and lower limbs).
- Routine lab tests. These include blood counts, urine analysis, lipid profile and measurement of liver enzymes and kidney function. If sexual desire is low, the levels of testosterone in the blood may be measured to determine if there are any endocrine abnormalities.
- Nocturnal penile tumescence testing (rigiscan). This test, which monitors if you have erections while asleep, can often help to determine whether the cause is predominantly psychological or physical. Physically healthy men have involuntary erections in their sleep; if these occur, the cause is more likely to be psychological. However, these tests are not completely reliable and have not been standardised.
These tests are only required in severe erectile dysfunction and are offered by specialist clinics. The modern era of effective oral treatment has reduced the indications for penile tumescence testing drastically.
- Tests to evaluate penile arteries and veins. This includes the use of medication to assess erections, ultrasound and angiography (a radiographic technique for examining the anatomy of a blood vessel). The latter is not commonly performed these days.
- Extensive nervous system tests. These are not standardised and are generally done only at major medical centres.
- Psychological evaluation. This may be recommended when a major psychological cause is suspected.
You and your doctor will use the results of the examination and tests to develop a treatment plan that may include medication, other non-surgical treatments or surgery.
Reviewed by Dr Dave Bowden MBBCh (Wits), FCS (SA) Urol. Specialist Urologist in private practice, Christiaan Barnard Memorial Hospital, Cape Town. (February 2015)