How are causes of
Erectile Dysfunction diagnosed?

Finding the causes of erectile dysfunction usually begins with a patient's medical and sexual history. The doctor interviews the patient for possible risk factors. Some doctors also use a printed questionnaire.

For the medical history, the patient will be asked questions covering a wide range of risk factors. Included will be questions about illnesses such as diabetes, heart disease and high blood pressure. Questions will be asked about any surgery, radiation exposure or accidental injuries and about smoking habits and alcohol intake. The patient will also be asked about medications he has taken in the past year.

For the sexual history, typical questions are: "When was the last time you had a normal erection?" "Do you ever wake up in the morning with an erection?" "When was the last time you had sexual intercourse?" The patient may be asked (1) whether his erections are painful or (2) if his penis is severely bent when erect. A "yes" to either question could indicate "Peyronie's disease, a condition caused by scar tissue in the penis. Additional questions may be asked to find out if there could by psychological reasons for the patient's erectile problems. In some cases, the doctor may refer the patient to a specialist for a more extensive psychological examination.

The next step after the medical and sexual history is a physical examination. The doctor will pay particular attention to the genitalia and will test nervous and vascular function as well as check for Peyronie's disease. The doctor may do a rectal examination to check the condition of the prostate.

Samples of the patient's blood and urine may be tested in a laboratory. Lab tests include measuring testosterone levels and testing for diabetes and vascular problems such as elevated cholesterol or fat in the blood. If necessary, additional special tests may be conducted. An example is using high-frequency sound waves (ultrasound) to check the condition of penile arteries. Another example is observing the response to drugs that normally stimulate an erection when injected into the penis.

Still another kind of special test measures "nocturnal penile tumescence and rigidity" (NPTR). For the NPTR test, the patient attaches 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 NPTR test measures these erections. If no nocturnal erection occurs or if the erection is impaired, the cause of the erectile dysfunction is likely to be physical. By contrast, a normal NPTR in a man with erectile dysfunction suggests a psychological cause.

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