Impotence Diagnosis (Erectile Dysfunction)
This article discusses the primary causes of impotence and the potential tests to identify it.
A problem like impotence can have many different causes. That’s why a doctor may need to use various examinations to diagnose the disorder in order to prescribe the appropriate treatment. Effective medication might also be prescribed, but only after establishing the root cause of your impotence.
The specialist should examine your medical history and conduct a thorough examination before requesting any tests. You’ll likely be asked about your personal and sexual life, so don’t regard such questions as too intimate or even indecent. It’s crucial that you answer them honestly. These questions could be the following:
- What preparations are you taking right now? This includes prescribed and over-the-counter drugs, herbal supplements, dietary supplements (BAA), as well as illegal drugs and alcohol.
- Have you recently encountered any psychological problems, such as stress, fear or depression?
- When did you notice the first signs of impotence?
- What is the frequency, quality and duration of your erections?
- Under what circumstances did the problem first occur?
- Do you or have you experienced spontaneous morning or nocturnal erections?
- What kind of techniques do you use while having sex?
- Are there any problems in your current relationship with your partner?
- Do you have relationships with multiple sexual partners?
- If you have more than one sexual partner, do you experience impotence with both/all of them?
Your doctor may also want to have a conversation with your sexual partner, because they may be able to identify possible reasons for your erectile problems.
After a full medical examination and discussion, you could be referred for any of the following tests:
- Full blood panel (general blood test): This is a complex blood analysis, which, among other things, can detect anemia. Anemia is caused by a low content of red blood cells in the blood and can amplify fatigue in the human body, which in turn can cause impotence.
- Functional liver and kidneys tests: These blood tests can determine whether the problem is a consequence of impaired liver or kidney function.
- Lipid test: This blood test measures your body’s level of lipids (fats), for example, cholesterol. A high level of lipids could indicate an atherosclerosis (hardening of the arteries), which can disrupt your circulation and blood flow to the penis.
- Functional diagnosis of the thyroid gland: The main function of thyroid hormones is to regulate the production of sex hormones, a lack of which can cause impotence.
- Hormonal blood test: The level of testosterone and prolactin in the blood and can be measured to detect any abnormalities.
- Urinalysis: This provides a range of information: for example, the level of protein, sugar and testosterone in your urine. If the content of such substances is different from normal, this could be a consequence of diabetes, kidney disease or a lower content of testosterone. Such problems can also lead to erectile dysfunction.
- Duplex scanning: This test is among the most effective for detecting causes of impotence. The ultrasonic scan uses high-frequency waves to create a visual estimation of your body’s tissues. For patients who suffer from impotence, duplex scanning can be applied to assess the state of your blood flow. Furthermore, it can identify markers of venous leakage and atherosclerosis, as well as assess the state of your vascular walls. The test is performed twice. First, while the penis is erect (often after the injection of a drug that stimulates erection), and then while it is relaxed.
- Bulbocavernosus reflex: This analysis detects the sensitivity of the nerve endings in your penis. The physician compresses the head of the penis, which should lead to contractions of your anal sphincter muscles. If the function of your nerve endings is impaired, the response will be slow or the muscle contractions might not occur.
- Nocturnal erection test: This analysis tests your erectile function during sleep. Usually a man experiences 5-6 episodes of erection during the night. The absence of spontaneous erections may indicate a problem with your nerve function or blood supply. For this examination, the doctors use two methods: a method for measuring the circumference of the penis and a method for measuring its stiffness. The first method is: three plastic loops of different tension are fixed around the penis. Your erectile function is determined by the loop that breaks. For the second method, the meter loops are tightened around the circumference of the organ at the root and apex. If an erection happens at night, the loops will tighten and the electronic device will record these changes.
- Penis biotesiometry: This test uses electromagnetic vibration to assess penis sensitivity and its innervations. A reduced sensitivity can indicate damaged nerves.
- Injection of a vasoactive drug: To conduct the test, an erection is induced by injecting a special solution that promotes the expansion (increase) of the blood vessels and the flow of blood to the penis.
- Dynamic infusion cavernosometry: The test is prescribed to men who are suspected of venous leakage. In this procedure, a special dye is injected into the blood vessels on the penis within a certain pressure. The specialist can determine the degree of venous leakage by measuring its physiological pressure, which is revealed by the level of liquid flow into the penis needed to maintain a firm erection.
- Cavernosography: This is conducted in conjunction with dynamic infusion cavernosometry. The test involves introducing a radiopaque substance into the penis. Then, an x-ray of the erect penis is taken to detect any venous leakage.
- Arteriography: This test is given to patients preparing for reconstructive vascular surgery. Doctors inject an x-ray contrast substance and perform an x-ray of the artery that is suspected to be damaged.
- PSA-test: PSA is the main indicator of prostate cancer. An abnormality in this investigation could mean a growth in the prostate or an infection, which can complicate the problem substantially.
Before you’re referred for any of these tests, the physician should explain them to you in detail. Don’t hesitate to ask questions if you have any.
This article was checked by medical professionals at the Cleveland Clinic’s Glickman Urological & Kidney Institute.