Niepłodność męska (impotencja) – Diagnostyka i diagnoza

Niepłodność męska (impotencja)
Diagnostyka i diagnoza

Niepłodność męska, definiowana jako niezdolność do osiągnięcia lub utrzymania erekcji umożliwiającej satysfakcjonujący stosunek seksualny, wymaga kompleksowej diagnostyki obejmującej szczegółowy wywiad medyczny, seksualny i psychologiczny oraz badanie fizykalne ukierunkowane na wykrycie zaburzeń naczyniowych, neurologicznych, hormonalnych i anatomicznych. W diagnostyce stosuje się standaryzowane kwestionariusze, takie jak Międzynarodowy Indeks Funkcji Erekcyjnej (IIEF-5) oraz Sexual Health Inventory for Men (SHIM), które oceniają nasilenie objawów i efektywność terapii. Badania laboratoryjne obejmują oznaczenie poziomu glukozy na czczo, profilu lipidowego, porannego poziomu testosteronu całkowitego, TSH oraz, w razie potrzeby, FSH, LH i prolaktyny. Analiza moczu pomaga wykluczyć cukrzycę i choroby nerek, a pełna diagnostyka kardiologiczna jest wskazana u pacjentów bez oczywistej przyczyny ED, ze względu na możliwe ukryte choroby sercowo-naczyniowe.

Diagnostyka niepłodności męskiej (impotencji)

Wywiad medyczny i badanie fizykalne
Kwestionariusze diagnostyczne
Badania laboratoryjne
Badania specjalistyczne
Ocena chorób współistniejących
Ocena czynników psychologicznych
Specyficzne grupy pacjentów
Podsumowanie procesu diagnostycznego
Kolejne rozdziały

Diagnostyka niepłodności męskiej (impotencji)

Niepłodność męska (impotencja) to schorzenie charakteryzujące się niezdolnością do osiągnięcia lub utrzymania erekcji wystarczającej do odbycia satysfakcjonującego stosunku seksualnego. Dotyczy znacznej części populacji męskiej, szczególnie po 40. roku życia. Prawidłowa diagnoza jest kluczowym elementem skutecznego leczenia tego zaburzenia.¹²

Wywiad medyczny i badanie fizykalne

Podstawą diagnostyki zaburzeń erekcji jest dokładny wywiad medyczny, seksualny i psychologiczny. Lekarz przeprowadza szczegółową rozmowę dotyczącą częstości, jakości i czasu trwania erekcji, a także okoliczności, w których występują problemy.³⁴ Podczas wywiadu istotne jest ustalenie, kiedy pojawiły się problemy z erekcją lub pożądaniem seksualnym, czy występują jakieś urazy mogące powodować dysfunkcję oraz czy pacjent doświadczył niedawno jakichkolwiek zmian fizycznych lub emocjonalnych.⁵

Badanie fizykalne jest niezbędnym elementem procesu diagnostycznego. Specjalista przeprowadza dokładne badanie w celu wykrycia ewentualnych zaburzeń naczyniowych, neurologicznych, hormonalnych lub anatomicznych. Szczególną uwagę zwraca się na narządy płciowe, aby wykluczyć strukturalne lub fizyczne problemy, takie jak choroba Peyroniego.⁶⁷ Podczas badania lekarze sprawdzają również ciśnienie krwi, odgłosy serca, które mogą wskazywać na nieprawidłowości naczyniowe wpływające na przepływ krwi do prącia.⁸

Kwestionariusze diagnostyczne

W diagnostyce zaburzeń erekcji powszechnie stosowane są wystandaryzowane kwestionariusze, które pomagają w ocenie nasilenia objawów oraz skuteczności leczenia. Najbardziej znanym narzędziem jest Międzynarodowy Indeks Funkcji Erekcyjnej (IIEF-5) – skrócona, pięciopunktowa wersja kwestionariusza, która pozwala na szybką kliniczną ocenę zaburzeń erekcji.⁹¹⁰ Kwestionariusz ten pomaga lekarzom ocenić pewność pacjenta co do osiągnięcia i utrzymania erekcji, sztywność erekcji odpowiednią do odbycia stosunku, zdolność utrzymania erekcji przez cały akt seksualny oraz ogólne zadowolenie z doświadczeń seksualnych.¹¹

Innym narzędziem jest Sexual Health Inventory for Men (SHIM), który również służy do oceny stopnia zaburzeń erekcji i monitorowania efektów terapii.¹² Te kwestionariusze są przydatnymi uzupełnieniami wywiadu klinicznego, jednak same w sobie nie są wystarczające do prawidłowego zdiagnozowania ED lub bezpiecznego leczenia.¹³

Badania laboratoryjne

Badania laboratoryjne są istotnym elementem diagnostyki zaburzeń erekcji, pomagającym w identyfikacji chorób podstawowych, które mogą przyczyniać się do ED. Standardowe badania obejmują:¹⁴¹⁵

Poziom glukozy na czczo – aby wykluczyć cukrzycę, która jest częstą przyczyną ED¹⁶¹⁷
Profil lipidowy – do oceny ryzyka chorób sercowo-naczyniowych¹⁸
Poranny poziom testosteronu całkowitego – do oceny funkcji hormonalnej¹⁹²⁰
Badania tarczycy (TSH) – do wykluczenia zaburzeń tarczycy²¹
W przypadku stwierdzenia niskiego poziomu testosteronu – badania FSH (hormonu folikulotropowego), LH (hormonu luteinizującego) i prolaktyny²²

Analiza moczu może dostarczyć informacji o poziomie cukru i białka w moczu, co pomaga lekarzowi określić, czy cukrzyca lub choroba nerek mogą przyczyniać się do zaburzeń erekcji.²³ Badania te są szczególnie ważne, ponieważ zaburzenia erekcji mogą być pierwszym objawem ukrytej choroby sercowo-naczyniowej, dlatego u wszystkich pacjentów bez oczywistej przyczyny ED należy przeprowadzić pełną diagnostykę kardiologiczną.²⁴²⁵

Badania specjalistyczne

W niektórych przypadkach, szczególnie gdy standardowe leczenie nie przynosi efektów lub gdy podejrzewa się specyficzne przyczyny organiczne, zaleca się przeprowadzenie bardziej zaawansowanych badań:²⁶²⁷

Badanie nocnych erekcji

Test nocnej tumescencji prącia (Nocturnal Penile Tumescence, NPT) monitoruje erekcje występujące podczas snu. U zdrowych mężczyzn podczas fazy REM snu występuje 5-6 erekcji. Ich obecność sugeruje, że przyczyna ED jest prawdopodobnie psychogenna, natomiast brak nocnych erekcji wskazuje na organiczną etiologię zaburzeń.²⁸²⁹³⁰ Badanie to polega na założeniu specjalnych urządzeń pomiarowych na penisa przed snem, które rejestrują liczbę, sztywność i czas trwania nocnych erekcji.³¹

Badania ultrasonograficzne

Ultrasonografia doplerowska prącia (Color Duplex Doppler Ultrasound, CDDU) jest nieinwazyjnym badaniem stosowanym do oceny przepływu krwi w prąciu. Badanie to wykonuje się przed i po podaniu środka rozszerzającego naczynia do ciał jamistych prącia (najczęściej prostaglandyny E1). Pozwala ono ocenić przepływ krwi w tętnicach prącia, zidentyfikować ewentualne blokady w tętnicach lub żyłach zaopatrujących prącie oraz określić, czy przyczyną ED jest niewystarczający dopływ krwi (niewydolność tętnicza) czy nieprawidłowy odpływ (dysfunkcja żylno-okluzyjna).³²³³

Za prawidłową szczytową prędkość przepływu krwi w badaniu doplerowskim uznaje się wartość powyżej 30 cm/s, a indeks oporności (RI) powyżej 0,8.³⁴

Test iniekcji farmakologicznej

Test iniekcji, zwany również iniekcją intrakawernozalną, polega na wstrzyknięciu leku rozszerzającego naczynia (np. prostaglandyny E1) do ciał jamistych prącia w celu sprawdzenia, czy penis może osiągnąć erekcję. Test ten pozwala ocenić, jak pełny staje się penis i jak długo utrzymuje się erekcja po podaniu leku. Jest to podstawowy test w diagnostyce przyczyn naczyniowych ED.³⁵³⁶³⁷

Połączony test iniekcji intrakawernozalnej i stymulacji (Combined Intracavernous Injection and Stimulation, CIS) jest najczęściej stosowanym testem do oceny i diagnostyki ED.³⁸

Badania zaawansowane

W wybranych przypadkach, szczególnie gdy rozważa się leczenie chirurgiczne, mogą być konieczne bardziej zaawansowane badania:³⁹⁴⁰

Dynamiczna kawernozonometria i kawernozonografia (Dynamic Infusion Cavernosometry and Cavernosography, DICC) – uznawane za złoty standard w diagnostyce ED pochodzenia żylnego. Badanie to pozwala na bezpośrednią ocenę odpływu żylnego i identyfikację miejsc przecieku żylnego.⁴¹⁴²
Selektywna angiografia prącia – złoty standard w diagnostyce wszystkich typów ED naczyniowego, jednak ze względu na inwazyjność stosowana jako metoda trzeciej linii.⁴³
Badania neurofizjologiczne – elektomiografia ciał jamistych, badanie przewodnictwa nerwu grzbietowego prącia – stosowane rzadko, głównie w przypadkach podejrzenia przyczyn neurologicznych ED.⁴⁴

Ocena chorób współistniejących

Zaburzenia erekcji często współistnieją z innymi schorzeniami, które mogą być ich przyczyną lub czynnikiem ryzyka. Dlatego istotnym elementem diagnostyki jest identyfikacja i ocena chorób współistniejących, takich jak:⁴⁵⁴⁶

Choroby sercowo-naczyniowe – ED może być wczesnym objawem choroby sercowo-naczyniowej i istotnym czynnikiem ryzyka przyszłych zdarzeń sercowo-naczyniowych⁴⁷⁴⁸
Cukrzyca – u pacjentów z cukrzycą ryzyko ED jest 3-4 razy wyższe niż w populacji ogólnej⁴⁹
Nadciśnienie tętnicze i hiperlipidemia – zwiększają ryzyko rozwoju ED⁵⁰
Otyłość – negatywnie wpływa na funkcję erekcyjną⁵¹
Hipogonadyzm i inne zaburzenia hormonalne – mogą przyczyniać się do rozwoju ED⁵²
Choroby neurologiczne (udar, choroba Parkinsona, stwardnienie rozsiane)⁵³
Zaburzenia psychiczne (depresja, lęk, stres)⁵⁴

Ocena tych chorób współistniejących jest kluczowa, ponieważ ich skuteczne leczenie może prowadzić do poprawy funkcji erekcyjnej oraz ogólnego stanu zdrowia pacjenta.⁵⁵

Ocena czynników psychologicznych

Chociaż większość przypadków ED ma podłoże organiczne, czynniki psychologiczne mogą odgrywać istotną rolę zarówno jako przyczyna pierwotna, jak i wtórna reakcja na problemy fizyczne. Ocena psychologiczna jest szczególnie ważna u młodszych mężczyzn, u których ED występuje nagle i jest związane z określonymi sytuacjami lub partnerami.⁵⁶⁵⁷

Jeśli podejrzewa się psychologiczne podłoże ED, lekarze oceniają:⁵⁸

Charakter początku zaburzeń (nagły lub stopniowy)
Charakter ejakulacji (zazwyczaj zmieniony przy przyczynach psychologicznych)
Obecność samodzielnie stymulowanych lub erotycznych erekcji
Problemy lub zmiany w związkach
Istotne negatywne wydarzenia życiowe lub problemy psychologiczne

W przypadku podejrzenia psychologicznego podłoża ED pacjent może zostać skierowany na bardziej szczegółową ocenę psychologiczną lub psychoseksualną.⁵⁹ Należy pamiętać, że czynniki psychologiczne odpowiadają za około 10-20% wszystkich przypadków ED i często są reakcją wtórną na istniejącą przyczynę fizyczną.⁶⁰

Specyficzne grupy pacjentów

Niektóre grupy pacjentów wymagają szczególnego podejścia diagnostycznego ze względu na specyficzne czynniki ryzyka lub przyczyny ED:⁶¹

Młodzi pacjenci z historią urazu miednicy lub narządów płciowych – mogą wymagać dodatkowych badań obrazowych⁶²
Pacjenci po leczeniu raka prostaty – ED występuje u do 85% pacjentów po radykalnej prostatektomii i u około 25% po radioterapii⁶³
Pacjenci z chorobami naczyniowymi – wymagają dokładnej oceny kardiologicznej⁶⁴
Pacjenci niereagujący na inhibitory PDE-5 – mogą wymagać bardziej zaawansowanych badań diagnostycznych⁶⁵

Podsumowanie procesu diagnostycznego

Diagnostyka zaburzeń erekcji jest procesem wieloetapowym, który powinien być dostosowany do indywidualnych potrzeb pacjenta. Zgodnie z zaleceniami towarzystw urologicznych, podstawowa diagnoza obejmuje:⁶⁶⁶⁷

Dokładny wywiad medyczny, seksualny i psychospołeczny
Badanie fizykalne ze szczególnym uwzględnieniem układu moczowo-płciowego
Podstawowe badania laboratoryjne (glukoza, lipidy, testosteron)
W wybranych przypadkach – specjalistyczne badania diagnostyczne

Należy pamiętać, że od czasu wprowadzenia doustnych inhibitorów PDE-5 i akceptacji terapii ukierunkowanej na cel w większości przypadków ED, uzasadnienie dla rozszerzonego testowania osłabło. Tylko niewielka część mężczyzn z ED odnosi korzyści z badań naczyniowych, które mogą zidentyfikować specyficzną dysfunkcję tętniczą lub żylną poddającą się rekonstrukcji chirurgicznej.⁶⁸

Prawidłowa diagnoza zaburzeń erekcji jest kluczowym elementem skutecznego leczenia tego schorzenia, które można leczyć skutecznie w niemal wszystkich przypadkach przy użyciu obecnie dostępnych metod terapeutycznych.⁶⁹

Kolejne rozdziały

Zapraszamy do dalszego czytania naszego leksykonu.

Wybierz kolejny rozdział z menu poniżej, aby otworzyć nową podstronę kompedium wiedzy i uzyskać szczegółowe informację o leku, substancji lub chorobie.

Materiały źródłowe

#1 Erectile Dysfunction – StatPearls – NCBI BookshelfTwitterFacebookLinkedInGitHubNCBI Insights BlogTwitterFacebookYoutube
https://www.ncbi.nlm.nih.gov/books/NBK562253/
Erectile dysfunction (ED) is a prevalent and multifaceted condition that predominantly afflicts males beyond 40 years, with its prevalence escalating globally. This condition is characterized by the consistent or recurrent inability to attain and maintain an erection sufficient for satisfactory sexual performance. […] The comprehensive evaluation and management of ED carry substantial importance. […] Fortunately, a plethora of therapeutic modalities is at the clinician’s disposal. These range from the administration of oral phosphodiesterase type 5 inhibitors, hormone replacement therapies, and external vacuum devices to the application of urethral suppositories, intracavernosal injections, topical gels, and sex therapy. This activity reviews the evaluation and treatment of ED and highlights the role of the interprofessional team in managing patients with this condition.
#2 Erectile Dysfunction | AAFP
https://www.aafp.org/pubs/afp/issues/2016/1115/p820.html
Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. ED becomes more common as men age. At least 12 million U.S. men 40 to 79 years of age have ED. […] The five-question International Index of Erectile Function (IIEF-5) allows rapid clinical assessment of ED and can measure the effectiveness of ED treatments. Other diagnostic options include a single-question self-assessment and the Brief Male Sexual Function Inventory. […] Impotence means not being able to get and keep an erection that is rigid enough for satisfactory sexual activity. […] ED has vascular, neurologic, psychological, and hormonal causes. Conditions commonly associated with ED include diabetes mellitus, hypertension, hyperlipidemia, obesity, testosterone deficiency, and prostate cancer treatment.
#3 Diagnosis of Erectile Dysfunction – NIDDK
https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/diagnosis
Health care professionals, including urologists, use your medical, sexual, and mental health history; a physical exam; and lab and other tests to diagnose erectile dysfunction (ED). […] A health care professional will take a medical, sexual, and mental health history to diagnose your ED. […] Health care professionals perform a physical exam to help diagnose ED. During the exam, they often check for blood vessel and nervous system issues, hormonal problems, and injury to or physical problems with the penis, such as Peyronies disease. […] Health care professionals may use lab, imaging, and other tests to help diagnose ED. […] To help find the cause of ED, your health care professional may use blood tests, including thyroid tests and prostate tests, and ultrasound imaging to show how blood flows through the penis.
#4 Diagnosis and Treatment of Erectile Dysfunction – Department of Urology
https://med.virginia.edu/urology/for-patients-and-visitors/mens-health-practice/erectile-and-sexual-dysfunction/diagnosis-and-treatment-of-erectile-dysfunction/
Most commonly, diagnosis will be the result of your doctor asking you about your symptoms and medical history, in association with a physical exam. Naturally, during the discussion, expect questions about the frequency, quality, and duration of your erections. […] Other tests that can assist the diagnosis are as follows: […] This test will monitor erections while you sleep. Involuntary erections during sleep are normal. If you have erectile dysfunction but have normal erections during sleep, the problem may be emotional. If you have problems with an erection even while you sleep, the problem may be physical. […] Doppler imaging is used to look at the blood flow. The test is done to check for blood flow in the penis. It will also look for blockage in the arteries or veins that supply the penis.
#5 Diagnosis of Erectile Dysfunction | PortalCLÃNIC
https://www.clinicbarcelona.org/en/assistance/diseases/erectile-dysfunction/diagnosis
In the light of an erection problem, the most important point is to understand its cause. If you have experienced erectile dysfunction for longer than six months, then you should talk to a medical specialist. […] In order to detect the cause, the doctor needs to know when the problems with erections or sexual desire began, if there are any injuries which could cause the dysfunction and if the patient has recently experienced any physical or emotional changes. The specialist also needs to know what medications you are taking, if any. […] The diagnosis of erectile dysfunction is based on a questionnaire that the patient completes alone, without the doctor being present. The most typical questionnaire is the IIEF-5 (International Index of Erectile Function-5). […] The assessment may include a physical examination and analytical tests to determine the testosterone levels in your blood. Depending on the results, the specialist may also request the analysis of other hormones, cholesterol or glucose levels as well as tests to determine the degrees of liver, kidney and thyroid function. Although it is not very common, some patients require special tests to assess their neurological function, blood vessels and circulation.
#6 Diagnosis of Erectile Dysfunction – NIDDK
https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/diagnosis
Health care professionals, including urologists, use your medical, sexual, and mental health history; a physical exam; and lab and other tests to diagnose erectile dysfunction (ED). […] A health care professional will take a medical, sexual, and mental health history to diagnose your ED. […] Health care professionals perform a physical exam to help diagnose ED. During the exam, they often check for blood vessel and nervous system issues, hormonal problems, and injury to or physical problems with the penis, such as Peyronies disease. […] Health care professionals may use lab, imaging, and other tests to help diagnose ED. […] To help find the cause of ED, your health care professional may use blood tests, including thyroid tests and prostate tests, and ultrasound imaging to show how blood flows through the penis.
#7 Erectile dysfunction | NHS inform
https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/erectile-dysfunction-impotence/
Your GP may assess your cardiovascular health. Narrowed blood vessels are a common cause of erectile dysfunction and linked with cardiovascular disease (conditions that affect the heart and blood flow). […] A physical examination of your penis may be carried out to rule out anatomical causes (conditions that affect the physical structure of your penis). […] Blood tests can also check for underlying health conditions. For example, measuring the levels of hormones such as testosterone can rule out hormonal conditions, such as hypogonadism (an abnormally low level of testosterone). […] If the cause of your erectile dysfunction is thought to be psychological, you may be referred for a psychological assessment.
#8 Erectile dysfunction tests and diagnosis next steps
https://www.singlecare.com/blog/erectile-dysfunction-tests-and-diagnosis/
During the physical exam, your doctor will listen to your heart and check your blood pressure to find any abnormalities, such as heart murmurs, that could affect blood flow to the penis. […] To rule out cardiovascular disease or diabetes, your doctor may also use blood tests and urine tests (urinalysis), to check your testosterone, cholesterol, blood sugar, and triglyceride levels. […] Generally performed by a specialist, an ultrasound is a simple procedure that can help identify any blood flow issues to your penis. […] Your doctor may ask questions about your mental health to screen for depression, stress, and anxiety, as these can all impair erectile function. […] This test is particularly helpful if its unclear whether your erectile dysfunction is from physical or psychological causes.
#9 Erectile Dysfunction | AAFP
https://www.aafp.org/pubs/afp/issues/2016/1115/p820.html
Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. ED becomes more common as men age. At least 12 million U.S. men 40 to 79 years of age have ED. […] The five-question International Index of Erectile Function (IIEF-5) allows rapid clinical assessment of ED and can measure the effectiveness of ED treatments. Other diagnostic options include a single-question self-assessment and the Brief Male Sexual Function Inventory. […] Impotence means not being able to get and keep an erection that is rigid enough for satisfactory sexual activity. […] ED has vascular, neurologic, psychological, and hormonal causes. Conditions commonly associated with ED include diabetes mellitus, hypertension, hyperlipidemia, obesity, testosterone deficiency, and prostate cancer treatment.
#10 Erectile Dysfunction | AAFP
https://www.aafp.org/pubs/afp/issues/2016/1115/p820.html
Medical and surgical history, sexual history, use of medications and other substances, and an assessment of psychological and relationship health are key components of the patient history. Essential parts of the physical examination include measurement of blood pressure, body mass index, and waist circumference to assess abdominal obesity; a genital examination; and an assessment of male secondary sex characteristics. […] The A1C or fasting glucose level can be used to assess for diabetes. A lipid panel can assess for hyperlipidemia. A thyroid-stimulating hormone level is recommended for men with signs or symptoms of hypothyroidism. […] Routine measurement of testosterone levels is controversial. As part of the Choosing Wisely campaign, the American Urological Association recommends that physicians not prescribe testosterone to men with ED who have normal testosterone levels. A diagnosis of hypogonadism must be based on more than just an abnormal laboratory test result.
#11 Differential Diagnosis of Erectile Dysfunction – Nursing CE Central
https://nursingcecentral.com/lessons/differential-diagnosis-of-erectile-dysfunction/
A physical examination can identify physical causes of ED. This includes assessing the sensitivity and appearance of the penis, which can indicate nerve or structural issues, such as those caused by Peyronie’s disease. The examination should explore signs of hormonal imbalances including abnormal hair growth or breast enlargement and check vascular health through blood pressure and pulse measurements in your wrists and ankles. […] Blood tests can help identify underlying conditions that might cause ED, such as diabetes, atherosclerosis, chronic kidney disease, or hormonal imbalances. The cause of ED often involves multiple factors, including physiological and psychological issues. Various conditions, such as neurological and endocrine disorders and medication side effects, may contribute to ED.
#12
https://link.springer.com/article/10.1007/s11930-014-0023-9
The Sexual Health Inventory for Men (SHIM): a 5-year review of research and clinical experience. […] The evolving role of testosterone in the treatment of erectile dysfunction. […] The rationale for prostaglandin E1 in erectile failure: a survey of worldwide experience. […] The management of erectile dysfunction: an AUA update. […] A randomized, double-blind, placebo-controlled evaluation of the safety and efficacy of avanafil in subjects with erectile dysfunction. […] EAU guidelines on erectile dysfunction: an update. […] The use of acupuncture in the treatment of erectile dysfunction. […] Psychosocial evaluation and combination treatment of men with erectile dysfunction.
#13 Erectile Dysfunction | Department of Urology
https://urology.uw.edu/patient-care/conditions-and-treatments/erectile-dysfunction
It is estimated that erectile dysfunction (ED) affects as many as 30 million men in the United States. […] The diagnosis of ED requires a detailed sexual and medical history, physical examination, and laboratory tests. […] Self-administered questionnaires are useful adjuncts to the case history, but they are not sufficient to diagnose ED correctly or treat it safely. […] Pharmacological, radiological, and psycho-physiological tests are used in efforts to determine the cause of ED. […] Intracavernosal injection, penile duplex Doppler ultrasonography, dynamic infusion cavernosometry and cavernosography, and internal pudendal arteriography all may be used to identify vasculogenic ED. […] Nocturnal penile tumescence testing can be useful to document an intact neurovascular axis, and the absence of nocturnal erectile activity may imply a neurogenic etiology.
#14 Diagnosis of Erectile Dysfunction – NIDDK
https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/diagnosis
Health care professionals, including urologists, use your medical, sexual, and mental health history; a physical exam; and lab and other tests to diagnose erectile dysfunction (ED). […] A health care professional will take a medical, sexual, and mental health history to diagnose your ED. […] Health care professionals perform a physical exam to help diagnose ED. During the exam, they often check for blood vessel and nervous system issues, hormonal problems, and injury to or physical problems with the penis, such as Peyronies disease. […] Health care professionals may use lab, imaging, and other tests to help diagnose ED. […] To help find the cause of ED, your health care professional may use blood tests, including thyroid tests and prostate tests, and ultrasound imaging to show how blood flows through the penis.
#15 Management of Erectile Dysfunction | AAFP
https://www.aafp.org/pubs/afp/issues/2010/0201/p305.html
The American Urological Association (AUA) recommends that the initial evaluation of ED include a complete medical, sexual, and psychosocial history. […] The five-item version of the International Index of Erectile Function Questionnaire is a validated survey instrument that can be used to assess the severity of ED symptoms. […] The AUA and World Health Organization recommend limited diagnostic testing in men with ED. This may include a fasting serum glucose level and lipid panel, thyroid-stimulating hormone test, and morning total testosterone level. […] Additional diagnostic testing and urologic evaluation may be warranted in cases of ED refractory to standard therapies.
#16 ED Tests: (Blood, Rigidity) Used By Urologists to Diagnose Erectile Dysfunction
https://www.webmd.com/erectile-dysfunction/diagnosing-erectile-dysfunction
Men need a lot of different body parts working the right way — from the brain and glands that control hormones to blood vessels and the penis — to get and keep an erection. Because of that, erectile dysfunction, or ED, can have a lot of causes. Some of them are physical; others are mental and emotional. […] With so many possible causes, your doctor has a number of tests they can use to figure out the best treatment for you. […] This ones not actually a test, but your doctor will likely start with questions about your medical and sexual history. The reason is simple: They want to better understand how ED affects you and see whether there might be a clear cause for it. […] Based on your physical exam as well as your medical and sexual history, your doctor may want to order certain blood or urine tests. Theyll use these to check for problems that can lead to ED, such as: Diabetes, Heart disease, Kidney disease, Hormonal problems such as low testosterone.
#17 Blood Tests for Erectile Dysfunction
https://www.healthline.com/health/erectile-dysfunction/blood-tests
A blood test can reveal issues beyond problems attaining or sustaining an erection. […] A blood test is a useful diagnostic tool for all sorts of conditions. Erectile dysfunction (ED) can be a sign of heart disease, diabetes mellitus, or low testosterone (low T), among other things. […] A blood test can determine whether you have a high sugar (glucose) level, high cholesterol, or low testosterone. […] Proper diagnosis and treatment are necessary to avoid further complications. […] According to the National Diabetes Information Clearinghouse (NDIC), as many as 3 in 4 men with diabetes have ED. […] For male diabetes patients, erectile dysfunction can occur up to 15 years sooner than for nondiabetics, the NDIC reports. […] You have a higher risk of developing ED if you have high blood pressure or high cholesterol, according to the Mayo Clinic.
#18 Erectile Dysfunction | AAFP
https://www.aafp.org/pubs/afp/issues/2016/1115/p820.html
Medical and surgical history, sexual history, use of medications and other substances, and an assessment of psychological and relationship health are key components of the patient history. Essential parts of the physical examination include measurement of blood pressure, body mass index, and waist circumference to assess abdominal obesity; a genital examination; and an assessment of male secondary sex characteristics. […] The A1C or fasting glucose level can be used to assess for diabetes. A lipid panel can assess for hyperlipidemia. A thyroid-stimulating hormone level is recommended for men with signs or symptoms of hypothyroidism. […] Routine measurement of testosterone levels is controversial. As part of the Choosing Wisely campaign, the American Urological Association recommends that physicians not prescribe testosterone to men with ED who have normal testosterone levels. A diagnosis of hypogonadism must be based on more than just an abnormal laboratory test result.
#19 Erectile Dysfunction (ED) Guideline – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline
Erectile Dysfunction: AUA Guideline (2018) […] The purpose of this guideline is to provide a clinical strategy for the diagnosis and treatment of erectile dysfunction (ED). […] Men presenting with symptoms of ED should undergo a thorough medical, sexual, and psychosocial history; a physical examination; and selective laboratory testing. (Clinical Principle) […] For the man with ED, validated questionnaires are recommended to assess the severity of ED, to measure treatment effectiveness, and to guide future management. (Expert Opinion) […] Men should be counseled that ED is a risk marker for underlying cardiovascular disease (CVD) and other health conditions that may warrant evaluation and treatment. (Clinical Principle) […] In men with ED, morning serum total testosterone levels should be measured. (Moderate Recommendation; Evidence Level: Grade C)
#20 Erectile Dysfunction Workup: Approach Considerations, Laboratory Studies, Injection of Prostaglandin E1
https://emedicine.medscape.com/article/444220-workup
Patients who express a loss of libido, depression, or any signs of diminished secondary sexual characteristics should undergo an endocrine evaluation. At a minimum, this should consist of measuring morning serum testosterone levels. […] The sensitivity of the skin of the penis to detect vibrational stimuli (ie, biothesiometry) can be employed as a simple nerve function office screening test, but it is infrequently indicated. […] Vascular function within the penis can be evaluated by means of duplex ultrasonography. In this procedure, blood flow in the cavernosal arteries within the corpora cavernosa is measured before and after the intracavernosal injection of a test dose of a standard vasodilator (eg, 20 g of PGE1). […] Nocturnal penile tumescence testing involves placing several bands around the penis, connected to a device such as the Rigiscan monitor, and instructing the patient to wear the assembly for 2 or 3 successive nights. If an erection occurs, which is expected during rapid eye movement sleep, its force and duration are measured on a graph. Inadequate or absent nocturnal erections suggest organic dysfunction, whereas a normal result indicates a high likelihood of a psychogenic etiology.
#21 Management of Erectile Dysfunction | AAFP
https://www.aafp.org/pubs/afp/issues/2010/0201/p305.html
The American Urological Association (AUA) recommends that the initial evaluation of ED include a complete medical, sexual, and psychosocial history. […] The five-item version of the International Index of Erectile Function Questionnaire is a validated survey instrument that can be used to assess the severity of ED symptoms. […] The AUA and World Health Organization recommend limited diagnostic testing in men with ED. This may include a fasting serum glucose level and lipid panel, thyroid-stimulating hormone test, and morning total testosterone level. […] Additional diagnostic testing and urologic evaluation may be warranted in cases of ED refractory to standard therapies.
#22 Azthena logo with the word Azthena
https://www.news-medical.net/health/Impotence-(Erectile-Dysfunction)-Diagnosis.aspx
If physical causes are suspected nature of onset (usually gradual), nature of ejaculation (usually unaltered), normal libido, medical history and ailments, history of operations, radiotherapy, or trauma to pelvis or scrotum or use of medications that may affect erection are assessed. […] This includes a complete examination of the genitals and urinary tract. […] Suggested investigations by the European Association of Urology include: […] Blood glucose and lipid profiles for all patients especially if not tested in the past 1 year. […] Total blood testosterone as measured in the morning sample. […] If low testosterone is detected then assessment of follicle stimulating hormone (FSH), luteinising hormone (LH) and Prolactin is prescribed. […] Examination of PSA (Prostate Specific Antigen) for patients with prostate abnormalities.
#23 Erectile Dysfunction Diagnosis | NYU Langone Health
https://nyulangone.org/conditions/erectile-dysfunction/diagnosis
Your doctor may ask you to provide a urine sample, so that he or she can obtain information about sugar and protein levels in the urine. This can help your doctor to determine if diabetes or kidney disease may be contributing to erectile dysfunction. […] A penile Doppler ultrasound enables your doctor to see how blood flows in the penis during and after an erection. The results help your doctor to diagnose and evaluate the extent of erectile dysfunction. […] Psychological factors are the cause of erectile dysfunction in about 10 percent of men. If no physical or medical causes explain your symptoms, your doctor may refer you to a psychologist for evaluation.
#24 Erectile Dysfunction – StatPearls – NCBI BookshelfTwitterFacebookLinkedInGitHubNCBI Insights BlogTwitterFacebookYoutube
https://www.ncbi.nlm.nih.gov/books/NBK562253/
Erectile dysfunction can be the first symptom of otherwise silent cardiac or vascular disease, so a full cardiovascular workup should be completed in all patients without an apparent cause of their ED. […] The prognosis of ED is dependent on the cause. Psychosexual causes generally have a good response to counseling, and most other causes of ED respond favorably to oral PDE-5 inhibitors. […] If not, there are multiple other options for treatment, including external vacuum devices, intraurethral prostaglandin pellets, intracavernosal injections, and combined therapy. Patients rarely fail all of these non-surgical options; there is still penile prosthesis implantation surgery, which remains highly successful. Almost every patient with ED can be treated successfully with the currently available therapies.
#25 Differential Diagnosis of Erectile Dysfunction – Nursing CE Central
https://nursingcecentral.com/lessons/differential-diagnosis-of-erectile-dysfunction/
Nocturnal Penile Tumescence (NPT) Test, although not a blood test, measures erections during sleep and can help distinguish between physical and psychological causes of ED. Tumescence refers to the state of being swollen. Nocturnal erection tests involve wearing a device around the penis overnight to monitor erections during sleep, helping to determine any physical or psychological factors for ED. […] Erectile dysfunction (ED) often arises from multifactorial causes. It is important to distinguish whether the condition stems from psychological factors or has an organic basis. The 1994 Massachusetts Male Aging Study (MMAS) found that 52% of men experience some degree of ED, with 10% being impotent. Medication-related ED occurs in 25% of cases due to blood pressure medications. […] Erectile dysfunction (ED) is an early sign of cardiovascular disease. Therefore, healthcare providers should assess men with ED for cardiovascular risk factors to prevent future major adverse cardiovascular events (MACE). Studies show that 50% of men with diagnosed coronary artery disease have ED.
#26 Management of Erectile Dysfunction | AAFP
https://www.aafp.org/pubs/afp/issues/2010/0201/p305.html
The American Urological Association (AUA) recommends that the initial evaluation of ED include a complete medical, sexual, and psychosocial history. […] The five-item version of the International Index of Erectile Function Questionnaire is a validated survey instrument that can be used to assess the severity of ED symptoms. […] The AUA and World Health Organization recommend limited diagnostic testing in men with ED. This may include a fasting serum glucose level and lipid panel, thyroid-stimulating hormone test, and morning total testosterone level. […] Additional diagnostic testing and urologic evaluation may be warranted in cases of ED refractory to standard therapies.
#27 Erectile Dysfunction | Department of Urology
https://urology.uw.edu/patient-care/conditions-and-treatments/erectile-dysfunction
However, since the introduction of oral PDE-I therapy and the acceptance of goal-oriented therapy for most cases of ED, the rationale for extensive testing has weakened. […] Only a small subset of men with ED benefit from vascular testing, which can identify specific arterial or venous dysfunction amenable to surgical reconstruction. […] For the vast majority, such testing is unlikely to change management strategy. […] Thus, specialized testing is now limited to PDE-I non-responders, young men with post-traumatic or primary ED, men with Peyronies Disease, and legal investigations.
#28 Diagnosis of Erectile Dysfunction – NIDDK
https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/diagnosis
A nocturnal, or nighttime, erection test checks for erections you have at night. The test can help health care professionals know if your ED is due to a physical problem. […] An injection test, also called intracavernosal injection, checks if the penis can get an erection. A health care professional injects a medicine into your penis to see how full the penis gets and how long an erection lasts.
#29 Azthena logo with the word Azthena
https://www.news-medical.net/health/Impotence-(Erectile-Dysfunction)-Diagnosis.aspx
Studies to test for nocturnal penile tumescence and rigidity. Normal individuals have five to six erections during sleep, especially during rapid eye movement (REM) sleep. Their absence may indicate a problem with nerve function or blood supply in the penis. […] Other tests include penile biothesiometry that uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis. […] A Penile Angiogram allows visualization of the blood circulation in the penis. […] Evaluation of psychological disorders. […] Presence of endocrinal or hormonal disorders […] Young patients with history of pelvic or genital trauma or injury […] Cardiovascular or nerve disorders leading to impotence […] Penile abnormalities that can be corrected by appropriate surgery […] Complex involvement of psychiatric, cardiovascular, psychosexual or endocrine components […] When requested by the patient or his sexual partner.
#30 Diagnosis and Treatment of Erectile Dysfunction – Department of Urology
https://med.virginia.edu/urology/for-patients-and-visitors/mens-health-practice/erectile-and-sexual-dysfunction/diagnosis-and-treatment-of-erectile-dysfunction/
Most commonly, diagnosis will be the result of your doctor asking you about your symptoms and medical history, in association with a physical exam. Naturally, during the discussion, expect questions about the frequency, quality, and duration of your erections. […] Other tests that can assist the diagnosis are as follows: […] This test will monitor erections while you sleep. Involuntary erections during sleep are normal. If you have erectile dysfunction but have normal erections during sleep, the problem may be emotional. If you have problems with an erection even while you sleep, the problem may be physical. […] Doppler imaging is used to look at the blood flow. The test is done to check for blood flow in the penis. It will also look for blockage in the arteries or veins that supply the penis.
#31 Erectile dysfunction tests and diagnosis next steps
https://www.singlecare.com/blog/erectile-dysfunction-tests-and-diagnosis/
Essentially, NPT testing monitors erections while you sleep. Erections while sleeping are normal and common. If you have an involuntary erection during sleep, the cause of your ED is likely emotional rather than physical. If you do not achieve erections when sleeping, it could indicate a physical cause.
#32 Erectile Dysfunction Diagnosis | NYU Langone Health
https://nyulangone.org/conditions/erectile-dysfunction/diagnosis
Your doctor may ask you to provide a urine sample, so that he or she can obtain information about sugar and protein levels in the urine. This can help your doctor to determine if diabetes or kidney disease may be contributing to erectile dysfunction. […] A penile Doppler ultrasound enables your doctor to see how blood flows in the penis during and after an erection. The results help your doctor to diagnose and evaluate the extent of erectile dysfunction. […] Psychological factors are the cause of erectile dysfunction in about 10 percent of men. If no physical or medical causes explain your symptoms, your doctor may refer you to a psychologist for evaluation.
#33 Current approaches to the diagnosis of vascular erectile dysfunction – Ma – Translational Andrology and Urology
https://tau.amegroups.org/article/view/38624/html
CDDU after intra-cavernous injection of vasoactive drugs has become a first-line method for the diagnosis of vascular ED, which can be used to determine the subtypes and severity of vascular ED. […] Selective penile angiography, which remains the gold standard method in the diagnosis of all types of vasculogenic ED, is considered to be a three-line method. […] DICC, which has been considered as the gold standard test to assess both arterial and venous ED, includes cavernosometry and cavernosography. Cavernosometry is used to detect the function of cavernous vessels, while cavernosography can directly reflex the venous reflux and observe the existence of venous leakage, which is of unique value in the diagnosis of venous ED. […] Intra-cavernous injection of vasoactive agent, CDDU, selective penile angiography, and DICC are commonly used in vascular examination to distinguish arterial insufficiency from venous occlusion dysfunction and other causes of ED.
#34
https://viasonix.com/vascular-angiology/penile-function/
For Doppler assessment of penile function, a peak systolic blood flow velocity above 30 cm/s is generally considered normal. In addition, an RI (Resistance Index) above 0.8 is also considered normal. […] PVR measurements that are considered normal include a short systolic rise time and a high amplitude, with a Dicrotic Notch in the waveform that may be present or absent.
#35 Diagnosis of Erectile Dysfunction – NIDDK
https://www.niddk.nih.gov/health-information/urologic-diseases/erectile-dysfunction/diagnosis
A nocturnal, or nighttime, erection test checks for erections you have at night. The test can help health care professionals know if your ED is due to a physical problem. […] An injection test, also called intracavernosal injection, checks if the penis can get an erection. A health care professional injects a medicine into your penis to see how full the penis gets and how long an erection lasts.
#36 ED Tests: (Blood, Rigidity) Used By Urologists to Diagnose Erectile Dysfunction
https://www.webmd.com/erectile-dysfunction/diagnosing-erectile-dysfunction
Your doctor may use an overnight erection test to see whether youre able to get an erection. […] An injection test is also called an intracavernosal test. Your doctor injects a medicine into the base of your penis that should give you an erection. If you dont get one, you may have a problem with blood flow to your penis. […] Sometimes called Doppler ultrasound, this is another way to check blood flow to the penis. It may be used along with the injection test. […] If it looks more likely that a mental or emotional issue is the source of the problem, your doctor will ask you standard questions about your mental well-being. They help them check for depression, anxiety, and other common causes of erectile dysfunction.
#37 Current approaches to the diagnosis of vascular erectile dysfunction – Ma – Translational Andrology and Urology
https://tau.amegroups.org/article/view/38624/html
For most patients with suspected ED, phosphodiesterase type 5 inhibitors (PDE5Is) treatment is commonly used while routine special diagnostic examinations are not recommended. Further examination was performed only if the patient was ineffective to oral PDE5Is. On the contrary, as mentioned above, ED, especially the vascular ED, is closely related to the occurrence of cardiovascular diseases. Further specific diagnostic examinations to patients with suspected vascular ED can identify etiology and risk factors, which is beneficial to their long-term prognosis. […] Intra-cavernous injection of vasoactive drugs is the firstly proposed method to diagnose vascular ED and laid the foundation for all other tests. Intra-cavernous injection of vasoactive agent was considered to be a rst-line treatment for ED before the introduction of oral PDE5Is in 1998, and it is still an important second-line treatment option of ED. More importantly, injection of vasoactive drugs into penile cavernous body plays a central role in the diagnosis of vascular ED.
#38 How is ED diagnosed? – Academic Urology & Urogynecology of AZ
https://www.academic-urology.com/how-ed-diagnosed.html
While ED causes can emerge from both psychological and physical conditions, the psychological factors are responsible for only 10%-20% of all cases of erectile dysfunction, and are often a secondary reaction to an underlying physical cause. […] The Combined Intracavernous Injection and Stimulation (CIS) Test is the most commonly used test for evaluating and diagnosing ED. […] A blood test is a useful diagnostic tool for all sorts of health issues, and can be used to determine if physical conditions such as heart disease, diabetes mellitus, or low testosterone (low T), among other things, are contributing to ED problems. […] Men can use a nocturnal penile tumescence (NPT) stamp test at night to confirm nocturnal erections. […] Learn about at-home ED tests, how to check for ED, and the professional diagnostic process for ED problems. […] How is ED diagnosed
#39 Erectile Dysfunction | Department of Urology
https://urology.uw.edu/patient-care/conditions-and-treatments/erectile-dysfunction
It is estimated that erectile dysfunction (ED) affects as many as 30 million men in the United States. […] The diagnosis of ED requires a detailed sexual and medical history, physical examination, and laboratory tests. […] Self-administered questionnaires are useful adjuncts to the case history, but they are not sufficient to diagnose ED correctly or treat it safely. […] Pharmacological, radiological, and psycho-physiological tests are used in efforts to determine the cause of ED. […] Intracavernosal injection, penile duplex Doppler ultrasonography, dynamic infusion cavernosometry and cavernosography, and internal pudendal arteriography all may be used to identify vasculogenic ED. […] Nocturnal penile tumescence testing can be useful to document an intact neurovascular axis, and the absence of nocturnal erectile activity may imply a neurogenic etiology.
#40 Erectile Dysfunction Workup: Approach Considerations, Laboratory Studies, Injection of Prostaglandin E1
https://emedicine.medscape.com/article/444220-workup
If the ultrasound study results point to veno-occlusive dysfunction (eg, show high end-diastolic velocities), dynamic cavernosometry and computed tomography cavernosography can be performed to confirm the diagnosis and identify the sites of venous leakage. […] In the vast majority of patients with ED, formal neurologic testing is unnecessary. However, those with a history of central nervous system (CNS) problems, peripheral neuropathy, diabetes, or penile sensory deficit may benefit from some level of neurologic testing.
#41 Current approaches to the diagnosis of vascular erectile dysfunction – Ma – Translational Andrology and Urology
https://tau.amegroups.org/article/view/38624/html
CDDU after intra-cavernous injection of vasoactive drugs has become a first-line method for the diagnosis of vascular ED, which can be used to determine the subtypes and severity of vascular ED. […] Selective penile angiography, which remains the gold standard method in the diagnosis of all types of vasculogenic ED, is considered to be a three-line method. […] DICC, which has been considered as the gold standard test to assess both arterial and venous ED, includes cavernosometry and cavernosography. Cavernosometry is used to detect the function of cavernous vessels, while cavernosography can directly reflex the venous reflux and observe the existence of venous leakage, which is of unique value in the diagnosis of venous ED. […] Intra-cavernous injection of vasoactive agent, CDDU, selective penile angiography, and DICC are commonly used in vascular examination to distinguish arterial insufficiency from venous occlusion dysfunction and other causes of ED.
#42 Dynamic Infusion Cavernosometry: Essential Test for ED Diagnosis – The Kingsley Clinic
https://thekingsleyclinic.com/resources/dynamic-infusion-cavernosometry-essential-test-for-ed-diagnosis/
Dynamic infusion cavernosometry (DIC) is a specialized diagnostic test used to evaluate vascular causes of erectile dysfunction (ED) and related penile conditions. It measures blood flow and pressure within the penis, helping healthcare providers identify specific issues contributing to a patientâs symptoms. […] Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. […] Dynamic infusion cavernosometry is considered the gold standard for diagnosing venous leakage. […] Dynamic infusion cavernosometry evaluates arterial insufficiency by measuring the pressure required to induce and maintain an erection. […] Dynamic infusion cavernosometry is a safe and effective method for evaluating penile vascular health. […] If the test reveals adequate blood flow and normal pressure retention in the penile tissue, it suggests that your erectile dysfunction is unlikely to be caused by vascular issues.
#43 Current approaches to the diagnosis of vascular erectile dysfunction – Ma – Translational Andrology and Urology
https://tau.amegroups.org/article/view/38624/html
CDDU after intra-cavernous injection of vasoactive drugs has become a first-line method for the diagnosis of vascular ED, which can be used to determine the subtypes and severity of vascular ED. […] Selective penile angiography, which remains the gold standard method in the diagnosis of all types of vasculogenic ED, is considered to be a three-line method. […] DICC, which has been considered as the gold standard test to assess both arterial and venous ED, includes cavernosometry and cavernosography. Cavernosometry is used to detect the function of cavernous vessels, while cavernosography can directly reflex the venous reflux and observe the existence of venous leakage, which is of unique value in the diagnosis of venous ED. […] Intra-cavernous injection of vasoactive agent, CDDU, selective penile angiography, and DICC are commonly used in vascular examination to distinguish arterial insufficiency from venous occlusion dysfunction and other causes of ED.
#44 Diagnosis and Treatment of Male Sexual Dysfunction | BCBSND
https://www.bcbsnd.com/providers/policies-precertification/medical-policy/d/diagnosis-and-treatment-of-male-sexual-dysfunction-2
The following diagnostic procedures are considered not medically necessary, as these tests do not have any therapeutic value because spinal cord injury and other neurological deficits that may cause erectile dysfunction are typically identified during a comprehensive history and examination: Corpora cavernosal electromyography; and Dorsal nerve conduction latencies; and Evoked potential measurements. […] The following treatments may be considered medically necessary for male sexual dysfunction: Vacuum constriction devices (e.g., ErecAid); or Vasodilator injection (e.g., papaverine, phentolamine, alprostadil); or Vasodilator suppository (e.g., alprostadil). Treatment of male sexual dysfunction not meeting the criteria as indicated in this policy is considered not medically necessary. […] Treatment of male sexual dysfunction with an internal penile prosthesis or an external device may be considered medically necessary when EITHER of the following criteria is met: Erectile dysfunction is due to an organic disease or injury and is not psychological in nature; or There is failure, a contraindication, or an intolerance to pharmacological therapy.
#45 Differential Diagnosis of Erectile Dysfunction – Nursing CE Central
https://nursingcecentral.com/lessons/differential-diagnosis-of-erectile-dysfunction/
Differential diagnoses to consider include: Abdominal Vascular Injuries, Cirrhosis Imaging, Depression, Hemochromatosis, Hypertension, Hypogonadism, Hypopituitarism (Panhypopituitarism), Noncoronary Atherosclerosis, Peyronie’s Disease, Scleroderma, Sickle Cell Disease (SCD), Type 2 Diabetes Mellitus. […] Causes of ED can be categorized into several types: psychological (including performance anxiety, stress, and relationship problems), endocrine (such as hypogonadism, hyperprolactinemia, thyroid disorders, and diabetes mellitus), neurogenic (including spinal cord injuries, multiple sclerosis, Parkinson’s disease, stroke, and peripheral neuropathy), and vascular (such as atherosclerosis, hypertension, peripheral artery disease, and heart disease). […] Conducting a thorough history and physical examination, alongside appropriate laboratory tests, is necessary. This approach helps identify the underlying cause of ED, allowing for the most effective treatment plan, addressing any reversible causes, and enhancing overall health outcomes.
#46 Differential Diagnosis of Erectile Dysfunction – Nursing CE Central
https://nursingcecentral.com/lessons/differential-diagnosis-of-erectile-dysfunction/
In addition to conditions considered in the differential diagnosis, it is essential to evaluate for other significant health issues that might contribute to erectile dysfunction. These include cancer and its treatments, epilepsy, multiple sclerosis, Guillain-Barr syndrome, Alzheimer’s disease, epispadias, widower syndrome (e.g. Takotsubo cardiomyopathy (TCM) broken heart syndrome), performance anxiety, malnutrition, leukemias, and the effects of various medications such as antidepressants, antipsychotics, antihypertensives, antiulcer drugs, and those used to treat hyperlipidemia. […] For the diagnosis and management of erectile dysfunction, the Process of Care Model provides a structured approach suitable for primary care and multidisciplinary settings. This model includes a rational approach to diagnosis and treatment, emphasizes thorough clinical history taking and a focused physical examination, mandates specialized testing and referrals in specific scenarios, and advocates a stepwise management approach that prioritizes treatment options.
#47 Current approaches to the diagnosis of vascular erectile dysfunction – Ma – Translational Andrology and Urology
https://tau.amegroups.org/article/view/38624/html
The association between vascular ED and cardiovascular disease has been widely recognized. Endothelial dysfunction is a common pathology of vascular ED and cardiovascular disease, and they share common risk factors such as obesity, tobacco, lack of exercise, diabetes, hypertension and hyperlipidemia. The most widely studied association between ED and cardiovascular disease is that ED patients have increased risks of not only cardiovascular events but also coronary heart disease and stroke. Also, the ED severity was regarded as the morbidity and mortality predictor of the future cardiovascular disease outcome. Through the investigation of 300 patients with angiographically documented coronary artery disease, ED may become evident before angina symptoms in almost 70% of cases. Young men with ED had a significantly increased risk of cardiac events in the future, while ED had little effect on the prognosis of older men. In this situation, identifying the causes of vascular ED and ascertaining potential risk factors may help to predict the occurrence of cardiovascular events and improve prognosis. Thus, this paper mainly focused on the advantages, limitations and application scenarios of existing methods for the diagnosis of suspected vascular ED.
#48 Differential Diagnosis of Erectile Dysfunction – Nursing CE Central
https://nursingcecentral.com/lessons/differential-diagnosis-of-erectile-dysfunction/
Nocturnal Penile Tumescence (NPT) Test, although not a blood test, measures erections during sleep and can help distinguish between physical and psychological causes of ED. Tumescence refers to the state of being swollen. Nocturnal erection tests involve wearing a device around the penis overnight to monitor erections during sleep, helping to determine any physical or psychological factors for ED. […] Erectile dysfunction (ED) often arises from multifactorial causes. It is important to distinguish whether the condition stems from psychological factors or has an organic basis. The 1994 Massachusetts Male Aging Study (MMAS) found that 52% of men experience some degree of ED, with 10% being impotent. Medication-related ED occurs in 25% of cases due to blood pressure medications. […] Erectile dysfunction (ED) is an early sign of cardiovascular disease. Therefore, healthcare providers should assess men with ED for cardiovascular risk factors to prevent future major adverse cardiovascular events (MACE). Studies show that 50% of men with diagnosed coronary artery disease have ED.
#49 Blood Tests for Erectile Dysfunction
https://www.healthline.com/health/erectile-dysfunction/blood-tests
A blood test can reveal issues beyond problems attaining or sustaining an erection. […] A blood test is a useful diagnostic tool for all sorts of conditions. Erectile dysfunction (ED) can be a sign of heart disease, diabetes mellitus, or low testosterone (low T), among other things. […] A blood test can determine whether you have a high sugar (glucose) level, high cholesterol, or low testosterone. […] Proper diagnosis and treatment are necessary to avoid further complications. […] According to the National Diabetes Information Clearinghouse (NDIC), as many as 3 in 4 men with diabetes have ED. […] For male diabetes patients, erectile dysfunction can occur up to 15 years sooner than for nondiabetics, the NDIC reports. […] You have a higher risk of developing ED if you have high blood pressure or high cholesterol, according to the Mayo Clinic.
#50 Erectile Dysfunction | AAFP
https://www.aafp.org/pubs/afp/issues/2016/1115/p820.html
Erectile dysfunction (ED) is the inability to achieve or maintain an erection sufficient for satisfactory sexual performance. ED becomes more common as men age. At least 12 million U.S. men 40 to 79 years of age have ED. […] The five-question International Index of Erectile Function (IIEF-5) allows rapid clinical assessment of ED and can measure the effectiveness of ED treatments. Other diagnostic options include a single-question self-assessment and the Brief Male Sexual Function Inventory. […] Impotence means not being able to get and keep an erection that is rigid enough for satisfactory sexual activity. […] ED has vascular, neurologic, psychological, and hormonal causes. Conditions commonly associated with ED include diabetes mellitus, hypertension, hyperlipidemia, obesity, testosterone deficiency, and prostate cancer treatment.
#51 Erectile Dysfunction (ED) Guideline – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline
For some men with ED, specialized testing and evaluation may be necessary to guide treatment. (Expert Opinion) […] For men being treated for ED, referral to a mental health professional should be considered to promote treatment adherence, reduce performance anxiety, and integrate treatments into a sexual relationship. (Moderate Recommendation; Evidence Level: Grade C) […] Clinicians should counsel men with ED who have comorbidities known to negatively affect erectile function that lifestyle modifications, including changes in diet and increased physical activity, improve overall health and may improve erectile function. (Moderate Recommendation; Evidence Level: Grade C) […] Men with ED should be informed regarding the treatment option of an FDA-approved oral phosphodiesterase type 5 inhibitor (PDE5i), including discussion of benefits and risks/burdens, unless contraindicated. (Strong Recommendation; Evidence Level: Grade B)
#52 Azthena logo with the word Azthena
https://www.news-medical.net/health/Impotence-(Erectile-Dysfunction)-Diagnosis.aspx
If physical causes are suspected nature of onset (usually gradual), nature of ejaculation (usually unaltered), normal libido, medical history and ailments, history of operations, radiotherapy, or trauma to pelvis or scrotum or use of medications that may affect erection are assessed. […] This includes a complete examination of the genitals and urinary tract. […] Suggested investigations by the European Association of Urology include: […] Blood glucose and lipid profiles for all patients especially if not tested in the past 1 year. […] Total blood testosterone as measured in the morning sample. […] If low testosterone is detected then assessment of follicle stimulating hormone (FSH), luteinising hormone (LH) and Prolactin is prescribed. […] Examination of PSA (Prostate Specific Antigen) for patients with prostate abnormalities.
#53 Differential Diagnosis of Erectile Dysfunction – Nursing CE Central
https://nursingcecentral.com/lessons/differential-diagnosis-of-erectile-dysfunction/
Differential diagnoses to consider include: Abdominal Vascular Injuries, Cirrhosis Imaging, Depression, Hemochromatosis, Hypertension, Hypogonadism, Hypopituitarism (Panhypopituitarism), Noncoronary Atherosclerosis, Peyronie’s Disease, Scleroderma, Sickle Cell Disease (SCD), Type 2 Diabetes Mellitus. […] Causes of ED can be categorized into several types: psychological (including performance anxiety, stress, and relationship problems), endocrine (such as hypogonadism, hyperprolactinemia, thyroid disorders, and diabetes mellitus), neurogenic (including spinal cord injuries, multiple sclerosis, Parkinson’s disease, stroke, and peripheral neuropathy), and vascular (such as atherosclerosis, hypertension, peripheral artery disease, and heart disease). […] Conducting a thorough history and physical examination, alongside appropriate laboratory tests, is necessary. This approach helps identify the underlying cause of ED, allowing for the most effective treatment plan, addressing any reversible causes, and enhancing overall health outcomes.
#54 Erectile Dysfunction Diagnosis | NYU Langone Health
https://nyulangone.org/conditions/erectile-dysfunction/diagnosis
Your doctor may ask you to provide a urine sample, so that he or she can obtain information about sugar and protein levels in the urine. This can help your doctor to determine if diabetes or kidney disease may be contributing to erectile dysfunction. […] A penile Doppler ultrasound enables your doctor to see how blood flows in the penis during and after an erection. The results help your doctor to diagnose and evaluate the extent of erectile dysfunction. […] Psychological factors are the cause of erectile dysfunction in about 10 percent of men. If no physical or medical causes explain your symptoms, your doctor may refer you to a psychologist for evaluation.
#55 Differential Diagnosis of Erectile Dysfunction – Nursing CE Central
https://nursingcecentral.com/lessons/differential-diagnosis-of-erectile-dysfunction/
The revised model (2018) emphasizes the modification of risk factors and the correction of comorbidities associated with ED as key components of patient management, including positive lifestyle changes, dietary improvements, and increasing physical exercise. First-line medical therapies should accompany these lifestyle modifications, including sexual counseling and therapy, which consider patient sexual dynamics, and pharmacotherapy with phosphodiesterase type 5 inhibitors (PDE5Is). […] The revised model underscores the essential role of healthcare providers in the assessment and treatment of men presenting with erectile dysfunction. According to the model, the initial assessment should comprise a comprehensive clinical history, a targeted physical examination, and specific laboratory tests. Subsequent management should be goal-oriented, considering the needs and preferences of both the patient and their partner.
#56 Erectile Dysfunction – StatPearls – NCBI BookshelfTwitterFacebookLinkedInGitHubNCBI Insights BlogTwitterFacebookYoutube
https://www.ncbi.nlm.nih.gov/books/NBK562253/
Erectile dysfunction (ED), formerly termed impotence, is defined as the failure to achieve or maintain a rigid penile erection suitable for satisfactory sexual intercourse. […] ED can be a symptom of a wide range of underlying pathologies and is an essential but underutilized cardiovascular risk factor. […] Any disease process that affects penile arteries, nerves, hormone levels, smooth muscle tissue, corporal endothelium, or tunica albuginea can cause erectile dysfunction. […] While the vast majority of patients with ED will have organic disease, some may have a primary psychological issue, particularly younger men. […] Fortunately, ED is almost always treatable. […] Before embarking upon any treatment or further investigations, clinicians must conduct a thorough medical history, detailed sexual history, and physical examination.
#57 ED Tests: (Blood, Rigidity) Used By Urologists to Diagnose Erectile Dysfunction
https://www.webmd.com/erectile-dysfunction/diagnosing-erectile-dysfunction
Your doctor may use an overnight erection test to see whether youre able to get an erection. […] An injection test is also called an intracavernosal test. Your doctor injects a medicine into the base of your penis that should give you an erection. If you dont get one, you may have a problem with blood flow to your penis. […] Sometimes called Doppler ultrasound, this is another way to check blood flow to the penis. It may be used along with the injection test. […] If it looks more likely that a mental or emotional issue is the source of the problem, your doctor will ask you standard questions about your mental well-being. They help them check for depression, anxiety, and other common causes of erectile dysfunction.
#58 Azthena logo with the word Azthena
https://www.news-medical.net/health/Impotence-(Erectile-Dysfunction)-Diagnosis.aspx
Patients with erectile dysfunction present with the inability to initiate or maintain an erection for satisfactory sexual intercourse. Diagnosis involves taking a detailed history and assessing the nature of the underlying cause of the impotence. […] Steps in diagnosis include: […] There are several approved questionnaires to assess sexual function and the effects of treatments. One of the questionnaires includes the International Index of Erectile Function (IIEF). […] Details of medical ailments like diabetes, high blood pressure, high blood cholesterol, hormonal disorders, prostate and pelvic disorders or surgeries etc. are assessed. […] If psychological causes are suspected nature of onset (usually sudden), nature of ejaculation (usually altered) presence of self-stimulated or erotic erections, problems or changes in relationships or major negative life events or psychological events are assessed.
#59 Erectile dysfunction | NHS inform
https://www.nhsinform.scot/illnesses-and-conditions/sexual-and-reproductive/erectile-dysfunction-impotence/
Your GP may assess your cardiovascular health. Narrowed blood vessels are a common cause of erectile dysfunction and linked with cardiovascular disease (conditions that affect the heart and blood flow). […] A physical examination of your penis may be carried out to rule out anatomical causes (conditions that affect the physical structure of your penis). […] Blood tests can also check for underlying health conditions. For example, measuring the levels of hormones such as testosterone can rule out hormonal conditions, such as hypogonadism (an abnormally low level of testosterone). […] If the cause of your erectile dysfunction is thought to be psychological, you may be referred for a psychological assessment.
#60 How is ED diagnosed? – Academic Urology & Urogynecology of AZ
https://www.academic-urology.com/how-ed-diagnosed.html
While ED causes can emerge from both psychological and physical conditions, the psychological factors are responsible for only 10%-20% of all cases of erectile dysfunction, and are often a secondary reaction to an underlying physical cause. […] The Combined Intracavernous Injection and Stimulation (CIS) Test is the most commonly used test for evaluating and diagnosing ED. […] A blood test is a useful diagnostic tool for all sorts of health issues, and can be used to determine if physical conditions such as heart disease, diabetes mellitus, or low testosterone (low T), among other things, are contributing to ED problems. […] Men can use a nocturnal penile tumescence (NPT) stamp test at night to confirm nocturnal erections. […] Learn about at-home ED tests, how to check for ED, and the professional diagnostic process for ED problems. […] How is ED diagnosed
#61 Azthena logo with the word Azthena
https://www.news-medical.net/health/Impotence-(Erectile-Dysfunction)-Diagnosis.aspx
Studies to test for nocturnal penile tumescence and rigidity. Normal individuals have five to six erections during sleep, especially during rapid eye movement (REM) sleep. Their absence may indicate a problem with nerve function or blood supply in the penis. […] Other tests include penile biothesiometry that uses electromagnetic vibration to evaluate sensitivity and nerve function in the glans and shaft of the penis. […] A Penile Angiogram allows visualization of the blood circulation in the penis. […] Evaluation of psychological disorders. […] Presence of endocrinal or hormonal disorders […] Young patients with history of pelvic or genital trauma or injury […] Cardiovascular or nerve disorders leading to impotence […] Penile abnormalities that can be corrected by appropriate surgery […] Complex involvement of psychiatric, cardiovascular, psychosexual or endocrine components […] When requested by the patient or his sexual partner.
#62 Diagnosis and Treatment of Male Sexual Dysfunction | BCBSND
https://www.bcbsnd.com/providers/policies-precertification/medical-policy/d/diagnosis-and-treatment-of-male-sexual-dysfunction-2
Penile revascularization may be considered medically necessary for the treatment of erectile dysfunction when ALL of the following criteria are met: The individual presents with erectile dysfunction preceded by blunt perineal or pelvic trauma; and The individual has erectile dysfunction that is secondary to a focal arterial occlusion, as evidenced by an arteriogram or duplex ultrasonography conclusive for focal arterial obstruction; and There is no evidence of generalized vascular disease (e.g., diabetes mellitus, hypertension, coronary artery disease), Peyronie’s plaques, intracavernosal masses, nodules, or sensory neuropathy; and There is evidence of normal corporeal venous function; and Alternative nonsurgical treatment modalities have been fully explained to the individual, and the individual is determined to achieve spontaneous erections without the need for pharmacological, external, or internal support devices; and The individual is not actively smoking. […] Venous ligation performed as a treatment for erectile dysfunction is considered not medically necessary.
#63 Differential Diagnosis of Erectile Dysfunction – Nursing CE Central
https://nursingcecentral.com/lessons/differential-diagnosis-of-erectile-dysfunction/
Post-operative ED is common in prostate cancer patients, with different treatments having varying impacts. Up to 85% of patients undergoing radical prostatectomy may experience ED, compared to a 25% rate in those receiving definitive radiation therapy. […] Initial treatment for erectile dysfunction (ED) focuses on enhancing overall health through lifestyle modifications, which not only improve erectile function but also reduce cardiovascular risk. Recommended lifestyle changes include increasing physical activity, adopting a Mediterranean diet or seeking nutritional counseling, and quitting smoking, drugs, and excessive alcohol consumption. […] Pharmacological treatments for erectile dysfunction (ED) offer effective options for improving sexual function and quality of life in affected men. Oral PDE-5 inhibitors, such as sildenafil, tadalafil, vardenafil, and avanafil, are the first-line treatment for ED due to their effectiveness across various causes including cardiovascular disease, diabetes, and hypertension.
#64 Erectile Dysfunction – StatPearls – NCBI BookshelfTwitterFacebookLinkedInGitHubNCBI Insights BlogTwitterFacebookYoutube
https://www.ncbi.nlm.nih.gov/books/NBK562253/
Erectile dysfunction can be the first symptom of otherwise silent cardiac or vascular disease, so a full cardiovascular workup should be completed in all patients without an apparent cause of their ED. […] The prognosis of ED is dependent on the cause. Psychosexual causes generally have a good response to counseling, and most other causes of ED respond favorably to oral PDE-5 inhibitors. […] If not, there are multiple other options for treatment, including external vacuum devices, intraurethral prostaglandin pellets, intracavernosal injections, and combined therapy. Patients rarely fail all of these non-surgical options; there is still penile prosthesis implantation surgery, which remains highly successful. Almost every patient with ED can be treated successfully with the currently available therapies.
#65 Erectile Dysfunction | Department of Urology
https://urology.uw.edu/patient-care/conditions-and-treatments/erectile-dysfunction
However, since the introduction of oral PDE-I therapy and the acceptance of goal-oriented therapy for most cases of ED, the rationale for extensive testing has weakened. […] Only a small subset of men with ED benefit from vascular testing, which can identify specific arterial or venous dysfunction amenable to surgical reconstruction. […] For the vast majority, such testing is unlikely to change management strategy. […] Thus, specialized testing is now limited to PDE-I non-responders, young men with post-traumatic or primary ED, men with Peyronies Disease, and legal investigations.
#66 Erectile Dysfunction (ED) Guideline – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline
Erectile Dysfunction: AUA Guideline (2018) […] The purpose of this guideline is to provide a clinical strategy for the diagnosis and treatment of erectile dysfunction (ED). […] Men presenting with symptoms of ED should undergo a thorough medical, sexual, and psychosocial history; a physical examination; and selective laboratory testing. (Clinical Principle) […] For the man with ED, validated questionnaires are recommended to assess the severity of ED, to measure treatment effectiveness, and to guide future management. (Expert Opinion) […] Men should be counseled that ED is a risk marker for underlying cardiovascular disease (CVD) and other health conditions that may warrant evaluation and treatment. (Clinical Principle) […] In men with ED, morning serum total testosterone levels should be measured. (Moderate Recommendation; Evidence Level: Grade C)
#67 Erectile Dysfunction (ED) Guideline – American Urological Association
https://www.auanet.org/guidelines-and-quality/guidelines/erectile-dysfunction-(ed)-guideline
For some men with ED, specialized testing and evaluation may be necessary to guide treatment. (Expert Opinion) […] For men being treated for ED, referral to a mental health professional should be considered to promote treatment adherence, reduce performance anxiety, and integrate treatments into a sexual relationship. (Moderate Recommendation; Evidence Level: Grade C) […] Clinicians should counsel men with ED who have comorbidities known to negatively affect erectile function that lifestyle modifications, including changes in diet and increased physical activity, improve overall health and may improve erectile function. (Moderate Recommendation; Evidence Level: Grade C) […] Men with ED should be informed regarding the treatment option of an FDA-approved oral phosphodiesterase type 5 inhibitor (PDE5i), including discussion of benefits and risks/burdens, unless contraindicated. (Strong Recommendation; Evidence Level: Grade B)
#68 Erectile Dysfunction | Department of Urology
https://urology.uw.edu/patient-care/conditions-and-treatments/erectile-dysfunction
However, since the introduction of oral PDE-I therapy and the acceptance of goal-oriented therapy for most cases of ED, the rationale for extensive testing has weakened. […] Only a small subset of men with ED benefit from vascular testing, which can identify specific arterial or venous dysfunction amenable to surgical reconstruction. […] For the vast majority, such testing is unlikely to change management strategy. […] Thus, specialized testing is now limited to PDE-I non-responders, young men with post-traumatic or primary ED, men with Peyronies Disease, and legal investigations.
#69 Erectile Dysfunction – StatPearls – NCBI BookshelfTwitterFacebookLinkedInGitHubNCBI Insights BlogTwitterFacebookYoutube
https://www.ncbi.nlm.nih.gov/books/NBK562253/
Erectile dysfunction can be the first symptom of otherwise silent cardiac or vascular disease, so a full cardiovascular workup should be completed in all patients without an apparent cause of their ED. […] The prognosis of ED is dependent on the cause. Psychosexual causes generally have a good response to counseling, and most other causes of ED respond favorably to oral PDE-5 inhibitors. […] If not, there are multiple other options for treatment, including external vacuum devices, intraurethral prostaglandin pellets, intracavernosal injections, and combined therapy. Patients rarely fail all of these non-surgical options; there is still penile prosthesis implantation surgery, which remains highly successful. Almost every patient with ED can be treated successfully with the currently available therapies.