Evaluation of sexual function begins with listening to what the concerns of a particular patient may be. Because of the multitude of mitigating factors (both physical and psychological) it is important to understand this difficulty form the patient’s point of view and perspective. Our department’s evaluation begins with a questionnaire of our own creation to begin to answer the question, “What’s happening to me?” In most cases, multiple factors can be identified and addressed. Circumstances permitting, patient’s partners are encouraged to accompany the patient and participate in the interview.
A complete understanding of the patient (both physical and psychological) is important in dictating further diagnosis. Erectile dysfunction can be the consequence of obvious disease or can be the first sign of a systemic disease (e.g. diabetes, heart disease, vascular disease) not previously recognized.
A general physical examination with particular attention to the vascular and neurological systems with particular attention to the genitalia can yield important insights.
Many patients have had basic laboratory evaluations performed prior to seeking the care of a urologist specializing in erectile dysfunction. These tests, alone and in combination can give important clues into factors contributing to ED. Lab test may include (tailored to individual patient):
- Complete Blood Count (CBC)
- Electrolyte Panel
- Renal Function
- Liver Function
- Endocrine Function (Thyroid, Testosterone, PSA)
FURTHER DIAGNOSTIC TESTS AND PROCEDURES
The following tests may be helpful in understanding what is happening (or not happening) and may be helpful in selecting future therapy. Specific testing is almost always “up to the patient” depending on their own personal perspective and goals for future treatment.
- Penile Color Flow Doppler Evaluation – evaluates penile anatomy and blood flow
- Cavernosography – evaluates penile blood flow and ability to maintain penile pressure
- Arteriography – evaluates arterial blood supply to the penis
- Nocturnal Penile Tumescence Testing – evaluates the number and intensity of erections during sleep