Erectile Dysfunction Diagnosis

This study lays out the process for diagnosing and treating erectile dysfunction (ED). 

Erectile dysfunction (ED) is when you cannot get or keep an erection firm enough to have intercourse. ED can occur from a physical cause such as disease, injury or side effects of drugs. Emotional issues, psychological issues or mental health issues can also worsen ED symptoms. ED is often treated by lifestyle changes, medications, using a vacuum device (to improve blood flow to the penis) or even surgery. 

ED can be hard to diagnose. This is because of both the physical and mental causes and different approaches doctors may take. This study outlines a standard approach for diagnosis and treatment. 

Databases were searched for ED studies. These studies took place between 1965 and 2017. From these studies, the authors outlined a process for ED diagnosis. 

1. Your doctor will carry out some examinations. These will included a physical and a blood test. Your doctor will also ask about your medical and family history. You will also be asked about your mental health and your sexual history. 

2. You will be asked to fill out some questionnaires to assess ED severity. You will also be asked if you're currently on treatment and how effective this treatment is. 

3. Testosterone levels will be tested in a morning blood test. 

4. Specialised testing may be required for some men. Morning erection assessment, injections into the penis and penile ultrasound, among others, may be performed. 

5. Your doctor will warn you about how ED can be connected to cardiovascular (heart and blood vessel) issues. Your doctor will also recommend seeing a mental health professional as ED can have psychological causes. 

6. Diet and lifestyle changes will be recommended. 

7. Your doctor may advise you of drug treatment:

8. One type of ED drug is called phosphodiesterase-5 inhibitors (PDE5-I). PDE5-I relax the muscles of the urinary tract. Your doctor will give you instructions for taking the medication. Your doctor will also inform you of the risks and benefits of the medication. Your doctor will also decide the dose you will be put on. Sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra) are examples of PDE5-I drugs. Your doctor will tell you about side effects of PDE5-I. These can include headache, flushing, back pain, nasal congestion, indigestion and dizziness, among others. Your doctor will also discuss taking PDE5-I with other medications. 

9. If you have previously had prostate cancer, your doctor will tell you PDE5-I may not be that helpful for ED.

10. For men whose ED is caused by a lack of testosterone, a mix of testosterone supplements and PDE5-I may be helpful.

11. Your doctor may tell you about vacuum devices. A vacuum device can be used to encourage blood flow to the penis and help ED. These devices are cheaper than drugs. They can also be bought over-the-counter. Some bruising may occur after use.

12. A device full of a drug called alprostadil (Caverject) may be injected into the urinary tract. This allows for the prolonged release of the medication. Your doctor will discuss the risks and benefits of this treatment with you if you are interested in it. 

13. Injections of alprostadil (Caverject), papaverine (Pavabid), phentolamine (Regitine) and atropine (AtroPen) may also be used. Only alprostadil is available in the USA for ED treatment. These injections are recommended for patients who PDE5-I are unsuitable for, or who don't like vaccuum devices. 

14. Penile prothesis is also used to treat ED. Your doctor will discuss the risks and benefits of a prosthesis with you. Your doctor will also discuss with you what you should expect after the implant. This procedure cannot be carried out when the patient has a urinary tract infection. Complications can include bruising, injury to the urethra (the tube that carries urine out of the body) and retaining urine. This procedure is irreversible.

15. For younger ED patients, re-construction of blood vessels in the penis may be considered. This procedure can only be carried out on a bigger blood vessel called an artery. The procedure is unsuitable for men who have cardiovascular issues. 

17. Your doctor may also tell you about newer therapies. These include: shockwave therapy, stem cell therapy and platelet-rich plasma therapy (a blood therapy). These therapies do not have much evidence to support them for ED. 

This study outlines a standard approach to ED diagnosis and treatment. All doctors should follow the same procedure. 

The authors note that different doctors may take different approaches to diagnosing and treating ED. 

If you are interested in learning more about ED, talk to your doctor.