Diagnosis of erectile dysfunction

Medical history

Your doctor will take a medical history to understand your general health. As part of this, you may be asked about other conditions you have and any factors that might contribute to ED.

Your doctor may ask you:

• If you take any medication
• If you smoke
• When and how much you drink
• If you drink much coffee or alcohol
• If you use recreational drugs on a regular basis
• If you ever had pelvic surgery
• If you have any heart and/or vascular problems
• If you have hormonal disorders
• If you have any psychological problems

Sexual history

Your doctor will also ask questions about your sexual life. These may feel very personal but are important for an accurate diagnosis and treatment.
Possible questions include:

• The status of your previous sexual relationships
• Your current sexual relationships
• Your current emotional state
• When the erectile problems started
• How long have the erectile problems lasted
• If you have seen another doctor specifically for ED
• If you have received treatment for ED before

You may be asked to describe the firmness and duration of your morning erections and erections with sexual stimulation. The doctor may also ask whether you have problems with arousal, ejaculation, or orgasm. If you have a sexual partner, it can sometimes be helpful to attend the consultation together.

Questionnaires

Your doctor may ask you to complete questionnaires that assess different aspects of sexual health. Commonly used tools include:

• The International Index for Erectile Function (IIEF)
• The Sexual Health Inventory for Men (SHIM)
• The International Prostate Symptom Score (IPSS)
• The Clinical Depression Questionnaire

Physical examination

Your doctor will perform a physical examination to look for abnormalities in the penis, scrotum, and testicles. To screen for cardiovascular disease, your blood pressure and heart rate may be measured, and a blood test may be ordered to check your cholesterol levels. Your doctor may perform a digital rectal examination to assess the size, shape, and consistency of the prostate, and if necessary, check the level of prostate-specific antigen (PSA) in your blood. To check for diabetes, a blood test may be used to measure your glucose level. It may also be necessary to measure your morning testosterone level with a blood test. .

Cardiac risk evaluation

Because erectile dysfunction and heart disease are related, your doctor will usually assess your cardiac risk as part of the evaluation. You may be referred to a cardiologist for further assessment and specific tests such as a ‘stress test’.

Laboratory testing

Laboratory tests may be ordered to look for metabolic disorders or other underlying conditions that may contribute to ED.

Other tests

In some situations, more specialised tests may be needed, such as:

• A nocturnal penile tumescence and rigidity (NPTR) test
• An intracavernous injection test
• Penile Doppler Ultrasound
• Neurological tests

These tests are not usually required for an initial diagnosis of ED and are reserved for selected cases where more detailed information is needed. If appropriate, your doctor may refer you to other specialists, such as a neurologist, psychiatrist, andrologist, or endocrinologist, for further evaluation.