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Impotence (Erectile dysfunction)

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of erectile dysfunction.

Diagnosis

The doctor typically interviews the patient about many physical and psychological factors.

Medical and Personal History. The doctor should take a medical and personal history and may ask about the following:

• Past and present medical problems
• Medications or drugs being used
• Any history of psychological problems, including stress, anxiety, or depression

Sexual History. In addition the doctor will ask about the patient's sexual history, which may include:

• The nature of the onset of the dysfunction
• The frequency, quality, and duration of any erections, and whether they occur at night or in the morning
• The specific circumstances when erectile dysfunction occurred
• Details of technique
• The patient's motivation for and expectations of treatment
• Whether problems exist in the current relationship

Interviewing the Sexual Partner. If appropriate, the doctor might also interview the sexual partner. In fact, including the partner in the counseling process is proving to be an important component in making the best treatment choices.

Physical Examination

The doctor should perform a careful physical exam, including examination of the genital area and a digital rectal examination (the doctor inserts a gloved and lubricated finger into the patient's rectum) to check for prostate abnormalities.

Trials Using Treatments for Erectile Function

A useful approach is to administer a treatment for erectile dysfunction and then observe the response. Doctors now usually recommend a trial of sildenafil (Viagra) to test for an erection response after 30 to 60 minutes. This drug is replacing more invasive and expensive tests, such as an injection of papaverine or prostaglandin E1, medications that dilate blood vessels in the penis. They produce an erection in about 15 minutes.

After administering the treatment and waiting the appropriate amount of time, the doctor then observes the erectile response, curvature of the penis, and response after erection, sometimes using an ultrasound scanner to assess blood flow.

Laboratory Tests

Blood Tests for Hormonal Abnormalities. Blood tests may be used to measure testosterone levels and, if necessary, prolactin levels to determine if there are hormone problems. The doctor may also screen for thyroid and adrenal gland dysfunction. In addition, various specific tests for erectile dysfunction can be performed.

Tests for Medical Conditions That May be Causing Erectile Dysfunction. Evidence of other medical conditions should be sought, particularly hypertension, diabetes, atherosclerosis, and nerve damage.

Monitoring Nighttime Erections

Tests that monitor nighttime erections may be used to determine if the causes of erectile dysfunction are more likely to be psychological. Neither of the following methods is helpful in determining a physical cause for erectile dysfunction.

Snap-Gauge Test. The snap-gauge test monitors the man's ability to achieve an erection during sleep. It is a very simple test.

• When the man goes to bed, he places bands around the shaft of his penis
• If one or more breaks during the course of the night, it provides evidence of an erection. In this case, a psychological basis for the erectile dysfunction is likely

RigiScan Monitor. A more sophisticated and expensive device is the RigiScan monitor, which makes repetitive measurements of rigidity around the base and tip of the penis. This test is quite accurate but may fail to detect mild cases of erectile dysfunction.

Penile Brachial Index

The penile brachial index is a measurement that compares blood pressure in the penis with the blood pressure taken in the arm. Problems with the arterial flow to the penis can be detected using this method.

Imaging Techniques

Imaging tests may be used in certain cases, but they are expensive and often limited to younger men. Anyone considering these tests should have them done in a specialized setting by professionals experienced in their use.

Dynamic Infusion Cavernosometry and Cavernosography. Dynamic infusion cavernosometry and cavernosography (DICC) is usually only given to young men in whom some blockage of the penis or physical injury of the pelvic area is suspected. After an erection is induced with drugs, the following four steps are taken:

• The penile brachial index is taken
• The storage ability of the penis is gauged
• An ultrasound of the penile arteries is performed
• An x-ray of the erect penis is taken

Unfortunately, this test and other similar imaging techniques used to determine blood flow in the penis are currently not very effective or accurate in diagnosing and determining treatment.

Duplex Doppler Ultrasound. An ultrasound technique called duplex Doppler ultrasound may be useful alone or with sildenafil (Viagra) in determining the severity of condition and also to determine impaired blood flow through the arteries.

• Review Date: 6/27/2006
• Reviewed By: Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital

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