The diagnosis of erectile dysfunction starts with a visit to a urologist.

Diagnosis of erectile dysfunction:

For men who are struggling with erectile dysfunction, the first step can be the hardest – telling your doctor about your experience. In reality, urologists consult with men on a regular basis to discuss their specific condition and concerns. The diagnosis of erectile dysfunction begins with a private and thorough evaluation of the patient.

Common evaluation protocol for erectile dysfunction includes reviewing the patient’s medical history, performing an in-office physical exam, ordering lab work, and utilizing various diagnostic tools.

Medical History

During their first visit, the patient will provide an extensive medical history, including psychological and sexual aspects of your life. There are many potential causes for impotency that can be identified through a detailed medical history. The urologist will also interview the patient to uncover possible contributing factors, including stress, fatigue and the relationship between the patient and his partner. These will include questions of a personal nature in order to establish an overview of the patient’s sexual experience. The provider will also need to know about lifestyle choices, such as smoking, alcohol consumption, or the use of recreational drugs, since these can contribute to ED. In addition, the evaluation will include questions about erection problems, existing medical conditions, and a review of medications that the patient is currently taking.

Physical exam

The in-office physical exam is straightforward and useful in identifying possible systemic problems. These issues may include:

Nervous system – If the penis is not sensitive to touch.
Endocrine system – Abnormal secondary sex characteristics, such as hair patterns, can point to hormonal problems.
Circulatory system – The doctor might discover a circulatory problem by observing decreased pulses in the wrists and ankles
Physical abnormalities – A penis that bends or curves when erect could be the result of Peyronie’s disease.

The physician may also do a rectal exam to check the condition of the prostate, and examine the thyroid gland.

Evaluation tools

The diagnosis of erectile dysfunction will include the use of evaluation tools that help the urologist identify its underlying cause.

Laboratory testing

Blood tests can indicate conditions that interfere with normal erectile function. These tests measure hormonal levels, such as testosterone, cholesterol, blood sugar (diabetes), liver and kidney function, and thyroid function. Excessive prolactin can lower testosterone levels, which can diminish libido.
Urinalysis may be ordered to rule out bladder infections. If necessary, additional special tests may be conducted.
Ultrasound imaging is used to check the condition of penile arteries. Ultrasound is used to evaluate blood flow, venous leaks, signs of atherosclerosis, and scarring or calcification of the erectile tissue.
Ultrasound testing is also used to evaluate penile erection after the injection of prostaglandin, a hormone-like stimulator produced in the body. Ultrasound imaging will capture vascular dilatation and measure penile pressure, which may also be measured with a special cuff. Measurements are compared to those taken when the penis is flaccid.
Nocturnal Penile Tumescence (NPT) testing involves attaching a pair of special gauges to his penis before going to sleep. Normally, men of all ages have erections during the dreaming (rapid eye movement) stages of their sleep. The NPT test measures those erections. If no nocturnal erection occurs, or if the erection is impaired, the causes of Erectile dysfunction are likely to be physical. By contrast, a normal NPT in a man with erectile dysfunction suggests a psychological cause. This testing is completed in a sleep lab.
Arteriography is a test that evaluates the penile arteries. This testing is performed by a radiologist who places a small tube in the femoral artery in the upper thigh, then finds the artery that goes to the penis. Once found, a contrast dye is injected in order to determine if there are any blockages in the penile arteries.
Cavernosometry and Cavernosography are the definitive tests for evaluating venous leak. In normal erection, the swelling of the penile tissue pinches off the veins to prevent blood from leaving the penis. When venous leak is present, blood flows into the penis, then immediately leaks from the veins. Cavernosometry evaluates if venous leakage occurs. Cavernosography is then performed to identify where the leak is.

If the urologist diagnoses erectile dysfunction, based on medical testing, there are several treatment options. Findings may also dictate the need to treat newly discovered medical conditions that are not currently being addressed.