Urology

Urological Conditions

Erectile Dysfunction

Diagnosis

Diagnosis of erectile dysfunction usually begins with the doctor taking your medical and sexual history, asking questions about how often you experience symptoms, your general physical and emotional state, and any drugs you’re currently taking that might cause erectile dysfunction. This will be followed by a physical exam and routine blood and urine tests that, among other things, can check your level of male hormones, cholesterol, blood sugar, and liver, kidney and thyroid function. The physical exam could include an examination of your prostate (called a digital rectal exam or DRE) in which the doctor physically feels the size, shape, and consistency of your prostate by inserting a gloved, lubricated finger into your rectum. An enlarged prostate can interfere with blood flow and nerve impulses in the penis.

There are several other diagnostic tests that can evaluate blood flow into and out of the penis and measure the blood pressure in it (normally and during erection) and evaluate the sensitivity and nerve function of the penis. Among the most common are:

Ultrasound. Uses sound waves projected into the body to create pictures of the organs and areas being examined; ultrasound of the genitals can show if there’s any problem with blood flow to the penis.

Neurologic exam. Tests the nerve function in the penis and checks for possible nerve damage in the genital area.

Nocturnal penile tumescence (NPT) test. Measures the number and strength of the erections you have during sleep; there are several simple methods for doing this.

Although they may not be aware of it, men normally have several (perhaps five or six) erections while they sleep, especially during rapid eye movement (REM) sleep. These erections are “automatic” and have absolutely nothing to do with the content of your dreams. (You don’t need to be dreaming about sex to have them). They happen about every 90 minutes and last for about 30 minutes. If you do not have them, or if they are especially weak, there may be a problem with the nerve function or blood supply in your penis.