Diagnosis

The diagnosis can be made in many cases based on the history of symptoms in the person. In other cases, to rule out more serious causes such as hypogonadism or prolactinoma, a physical examination and laboratory investigations are done.

Differentiating between physiological and psychological ED is one of the first steps. Determining whether there are involuntary erections is important in removing the possibility of psychogenic causes for ED. Occasionally having full erections, such as nocturnal penile tumescence while asleep (that is, while mental and psychological problems, if any, are less present), appears to indicate that the physical systems are functioning functionally. Similarly, manual-stimulated performance and any performance anxiety or acute situational ED can suggest a psychogenic component to ED.

Certain factors contributing to ED are diabetes mellitus, which is a well-known cause of neuropathy).ED is often correlated with generally poor physical health, poor eating habits, obesity, and more commonly cardiovascular disease, such as coronary artery disease and peripheral vascular disease. It's important to check for cardiovascular risk factors including smoking, dyslipidemia , hypertension and alcoholism.

For certain particular cases, the simple quest for a previously undetected groin hernia can be helpful because it can affect men's sexual functions and is fairly easy to treat.

A classification for ED has been included in the latest diagnostic and statistical manual for mental disorders (DSM-IV).

Ultrasonography

Ultrasonography of penile with doppler can be used to analyze the erected state of the penis. Most cases of organic causal ED are due to changes in blood flow in the corpora cavernosa, characterized by occlusive artery disease, most frequently of atherosclerotic origin, or a failure of the veno-occlusive system. The penis should be tested in B mode prior to the ultrasound test with Doppler to detect potential tumors, fibrotic plaques, calcifications, or hematomas, as well as to determine the presence of the cavernous arteries that may be tortuous or atheromatous.

The injection of 10-20 μg of prostaglandin E1 will cause erection, with arterial flow tests every five minutes for 25-30 min. The use of prostaglandin E1 is contraindicated in patients with priapism predisposition (e.g. those with sickle cell anemia), as well as in patients with penis or penile implant anatomical deformity. For certain cases phentolamine (2 mg) is added. Stimulation of both visual and tactile results better. In cases of contraindications, some writers suggest using sildenafil by mouth to replace the injectable medications, but the efficacy of such treatment is controversial.

The flow pattern is monophasic, with low systolic velocities and a lack of diastolic flow prior to injection of the chosen drug. After injection, systolic and diastolic peak velocities are expected to increase, gradually decreasing with vein occlusion and becoming negative when the penis becomes rigid (see image below). The reference values range from > 25 cm / s to > 35 cm / s through studies. Values above 35 cm / s indicate an absence of arterial disease, values below 25 cm / s indicate an arterial insufficiency, and values below 25–35 cm / s are indeterminate because they are less precise. The data obtained would correspond with observed degree of erection. If the peak systolic velocities are natural, the final diastolic velocities should be measured, associating those over 5 cm / s with venogenic ED.

Other workup methods

Penile nerves function

Tests such as the bulbocavernosus reflex test are used to assess if the penis has adequate nerve sensation. The doctor squeezes the penis glans (head) which causes the anus to contract immediately if nerve function is normal. The delay between squeeze and contraction is determined by a doctor by watching the anal sphincter or by feeling it with a gloved finger inserted past anus.

Nocturnal penile tumescence (NPT)

During sleep, it is common for a man to have five to six erections, particularly during rapid eye movement ( REM). Their absence can signify a nerve function or blood supply problem in the penis. Throughout nocturnal erection, there are two methods of calculating increases in penile rigidity and circumference: snap gage and strain scale. However, a large proportion of men who do not have a sexual disorder do not have daily nocturnal erections.

Penile biothesiometry

This test uses electromagnetic stimulation in the glans and shaft of the penis to determine the sensitivity and nerve functions.

Dynamic infusion cavernosometry (DICC)

Technique where the fluid is injected at a specified rate and pressure into the penis. This gives measurement of the vascular pressure during an erection in the corpus cavernosum.

Corpus cavernosometry

Measurement of vascular pressure in corpus cavernosum by cavernosography. Under strain, saline is injected with a butterfly needle into the corpus cavernosum, and the flow rate needed to sustain an erection indicates the level of venous leakage. The responsible leaking veins may be visualized by infusing a mixture of the contrast medium saline and x-ray and performing a cavernosogram. The images are obtained digitally in Digital Subtraction Angiography (DSA).

Magnetic resonance angiography (MRA)

This is similar to magnetic resonance imaging. Magnetic resonance angiography uses radio waves and magnetic fields to provide accurate pictures of the blood vessels. Doctors that inject a "contrast agent" into the bloodstream of the individual that causes the vascular tissues to stand out from other tissues. The contrast agent provides for enhanced blood supply information and vascular anomalies.