Diagnosing ED may require a physical and/or a psychological examination along with medical history taking. Accurate diagnosing comes from holistic evaluation – often many think that surgery such as penile implants are the only option when it comes to treating Erectile Dysfunction. That is simply not true.
A doctor – a sexual health professional – is the one that diagnoses ED – through history taking and a psychological and/ or physical exam. At times it can be challenging to speak about sexual health concerns with a professional, but remember that a healthy sex life is part of living a healthy life.
There are various treatment options available for ED, and this is dependent on the severity and diagnosis of any abnormalities in sexual function. Medical treatments include medicative intervention such as PDE-5 inhibitors and psychological counselling. Surgery is never considered unless it’s the last option, these cases are rare. Also, it is not strongly advised as there could be side-effects.
Not all cases require a physical examination.
The process of undergoing diagnostic tests and imaging helps a professional determine the cause behind the patient’s ED along with ruling out any underlying medical conditions.
Here’s what the diagnostic process for ED may entail (not every patient with ED needs all the following tests; it is decided on a case-by-case basis):
The diagnostic procedure for ED many include all or some of the following:
Medical and sexual history
Symptoms can be distinguished between an erection, ejaculation, desire or orgasm concern. Medical history can reveal any diagnosis or disease that can affect reproductive or sexual health. Sexual history will help professionals identify any key concerns or signs that their patient may have missed or been unable to identify.
For example, many may not know that they could have a heart disease (such as coronary artery disease), or some other medical condition – many miss signs such as increased fatigue or constant coughing, etc. In a similar manner, many individuals don’t take care of their high blood pressure – hypertension or increased blood pressure can lead to many other health concerns besides sexual dysfunctions such as ED.
Understanding medical history is important, you should tell your doctor if you:
- Have undergone chemotherapy or prostate cancer treatment
- Are on any oral drugs such as nitrate medications, anti-psychotics, anti-hypertensives, chemotherapy medications, anti-seizure medications
- Have undergone reproductive surgery such as pelvic surgery
- Have been diagnosed with any chronic diseases or physical conditions such as chronic kidney failure or kidney disease, heart conditions, chronic sleep disorders, sudden drops in blood pressure, or any other risk of complications that could affect erectile function.
- Have been diagnosed with any psychological conditions such as anxiety or depression
- Have had any physical injury or pelvic trauma
Some questions that your doctor may ask you can include:
- How would you rate the hardness of your erection? (during masturbation or sexual intercourse)
- How long have you been experiencing ED symptoms?
- How often are you active with your sex life?
There are various conditions that can be causes of Erectile Dysfunction symptoms:
- Medical conditions such as cardiovascular disease, diabetes mellitus, vascular disease
- Sexual dysfunctions such as low sexual desire or sexual arousal, sexual performance anxiety, premature ejaculation
- Hormonal levels fluctuation such as low blood or serum testosterone levels
- Oral Medications such as anti-psychotics, anti-hypertensives
- Interpersonal or relationship issues
- Mismanagement of erectile dysfunction symptoms
- Untreated chronic health and mental health conditions
- Genetic risk factors such as heart attacks or past cardiovascular events
Physical examination of external penis anatomy
This helps professionals identify any physical concerns such as reflexes, secondary sex characteristics that could identify hormonal/endocrine related conditions. The basis is to identify anything abnormal and analyse its correlation with the symptoms presented. This can help professionals understand the specific symptoms of the sexual dysfunction and curate a treatment plan that best suits their patient.
Lab tests
- Blood tests/hormone levels check: Tests such as complete blood count (CBC) to rule out medical conditions such as diabetes, and heart disease along with checking testosterone levels.
- Urinalysis: can detect certain underlying medical conditions
- Lipid profile testing
- Creatine levels check
- Liver enzymes check
- Thyroid function
- Overnight Erection Test: It is common for men to experience about 3 to 5 erection when they sleep. This test will help measure how many erections you have during the night and how firm or strong they are. If erections are experienced in the night but nor during other times, the cause behind ED symptoms could be psychological – i.e., Psychogenic Erectile Dysfunction.
- Injection Test: This is a procedure where medicine is injected at the base of the penis to induce an erection. If an erection doesn’t occur, there could be a concern with blood flow in the penis.
It is important to remember that lab tests are only prescribed based on medical and sexual history. It is not that all patients are prescribed all of the above. These tests are critical to those experiencing chronic medical conditions – such as diabetic patients (insulin resistance), neurological diseases, high body fat or obesity, myocardial ischemia, hypertensive patients, those addicted to drugs etc – it helps determine risk and treatment prognosis.
Psychological examination
This is to rule out or treat mental health conditions such as depression, and/or anxiety. Emotional issues or concerns can impact psychological health deeply – and while it isn’t common knowledge that psychological factors can affect erectile function, much research has proven quite the opposite. Traumatic events such as abuse, or depressive symptoms can lead to symptoms of ED due to the anxiety, fear and confusion that can come with situations as such.
Improvement in erectile functioning depends both on mind and body – referred to as the ‘hardware’ and ‘software’ respectively. Since, mental health plays a huge role in sexual wellness, it is always considered when sexual disorders are being evaluated and treated. Counselling and therapy has an unnecessary taboo associated with it.
Besides depression and anxiety – common psychological disorders – relationship conflicts are also key in causing types of sexual dysfunction. It can significantly impact ones sex life, sexual stimulation, desire etc.
Imaging: Ultrasound (US)
A doppler US is done of the penis and testicles to check for blood flow issues or any other problems. This imaging tests helps professional understand if there is poor blood flow through the penis. It isn’t a painful procedure and is commonly conducted by a radiologist or urologist.
The management of erectile dysfunction is possible – the goal is to help the patient experience erection sufficient enough for sexual intercourse. While holistic evaluation requires determining association with risk factors (such as cardiovascular risk factors), diagnosis allows for treatment plans to be effective to the dysfunction in patients.
Advanced Erectile Function Tests
- Penile biothesiometry
- Bulbocavernosus reflex
- Arteriography
- Cavernosography
- Vasoactive injection
- Nocturnal penile tumescence (NPT)
- Dynamic infusion cavernosometry
Risk Factors of Erectile Dysfunction
Erectile Dysfunction, being one of the most common sexual dysfunctions in men, can create both, a physical and psychological impact. Due to the lack of education, and the stigma associated with sexual healthcare and counselling, many are unaware of the risks they take when they choose to not treat their sexual concerns.
This, widely, is because people are unaware of the treatments available to treat Erectile Dysfunction. Most, too, are unaware that the symptoms they may be facing could be associated with the sexual disorder.
Understanding the risks factors associated with ED, and being clear on how it’s diagnosed and treated can help relieve anxiety and hesitancy in seeking professional help.
Risk factors associated with ED increase the chances (‘risk’) of an individual experiencing the sexual disorder. This does not mean, however, that it does so all the time and for everyone. The ‘Risk Factors’ list below refers to the most common risk factors that are associated with ED.
- Injury to the pelvic area damaging penile nerve function and/or penile arteries
- Medical or chronic health conditions such as heart or cardiovascular disease, diabetes (high blood sugar or blood glucose levels), peripheral artery diseases, hypertension (increased blood pressure)
- Prostate, colon, rectum, or bladder surgery
- Chronic alcoholism, continuous nicotine (tobacco products), and recreational drug use
- Certain medications such as antidepressant medications
- Mental health conditions such as anxiety (including OCD) and depression
- Obesity: which can weaken pelvic floor muscles
- Reproductive surgeries: prostate surgery, pelvic surgery or other surgical treatments
- Chemotherapy or radiation
While the main symptom of ED remains the inability to sustain an erection or have an erection firm enough for sexual intercourse, there are also other factors that play role in when one is experiencing those symptoms. For example, experiencing ED can lead to Low Sexual Desire or even Performance Anxiety.
Conditions that lead to hormonal fluctuations (such as low levels of testosterone or elevated prolactin levels) or blood flow restrictions and blood circulation have a greater risk of leading to ED. This is because blood flow is a critical part of getting and sustaining an erection.
