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Diagnosis - ED

Evaluation of Sexual Dysfunction

  • History
    • Physiologic changes
    • Psychologic dysfunction
    • Organic deterioration
  • Physical Examination
    • Look for changes compatible with endocrine disease, i.e., gynecomastia
    • Examine the penis and testes (both size and texture), prostate, and seminal vesicles
    • Thorough neurologic examination
  • Laboratory Data, Hormonal Evaluation
    • Screening blood chemistries to rule out diabetes and renal failure
    • A hormonal evaluation that includes testosterone, prolactin, and LH should be obtained
  • Special Studies to Evaluate Sexual Dysfunction
    • Psychological testing
      • The Beck Depression Inventory
      • The Minnesota Multiphasic Personality Inventory
    • Nocturnal penile tumescence (NPT)
      • Doppler studies. To detect impaired hemodynamic blood flow parameters
      • [Penile brachial index (PBI): less than 0.7] is considered compatible with arterial vasculogenic impotence
      • Dynamic infusion cavernometry and cavernosography (DICC)
      • Angiography
        • Assessment of autonomic pathways (neurologic testing)
          • Cystometrography and bethanechol supersensitivity testing
          • Perineal electromyography and bulbocavemous reflex latency testing
          • Examination of the suprasacral afferent pathways through testing of the genitocerebral evoked response
            • Assesment of cavernous tissues

References

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  • Dinsmore W, Evans C: ABC of sexual health: Erectile dysfunction. Br Med J 318:387-390, 1999.
  • Eid JF, Dutta TC: Vacuum constriction devices for erectile dysfunction: A longterm, prospective study of patients with mild, moderate, and severe dysfunction. Urology 54:891-893: 1999.
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