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:
Nocturnal Penile Tumescence Testing
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.
A Note About Premature Ejaculation
Whereas erectile dysfunction is a man’s inability to attain or maintain an erection sufficient for satisfactory sexual performance, premature ejaculation is ejaculation which occurs sooner than desired and typically before or shortly after penetration. This is persistent, diminishes the satisfaction related to the sexual encounter and causes substantial distress to the patient and his partner. Premature ejaculation is the most common sexual dysfunction reported by men. Differentiating between erectile dysfunction and premature ejaculation is crucial in determining an appropriate treatment strategy. Treatment options include behavioral, topical, and oral therapies and can be selected following a discussion with your provider.
Treatment of Erectile Dysfunction
Your doctor may prescribe:
- Phosphodiesterase inhibitors. (Do not take these medications if you are also taking nitrates.)
- Oral testosterone , if you have low testosterone levels.
- Alprostadil , either injected into the penis or inserted into the urethra as a suppository.
- Popular medications such as Sildenafil (Viagra) or Tadalafil (Cialis).
Use caution and talk to your doctor before taking any over-the-counter medications for erectile dysfunction. Some of them may be unsafe.
Prior to sexual activity, a vacuum device pulls blood into the penis. A band is then placed around the penis to keep the erection. Most vacuum devices include:
- A plastic cylinder for the penis.
- A hand pump for pumping air out of the cylinder.
- An elastic band for holding the erection after removal of the cylinder
Implants can be surgically placed in the penis. Prior to sexual activity, the implants are then inflated via fluid pumped from a small reservoir near the implants, thus creating an erection.
After sexual activity, the fluid then returns to the reservoir, thus deflating the implants and allowing the penis to return to non-erect size. (See associated illustration.)
Vascular surgery is done to repair blood vessel leaks in the penis. This has been shown to be effective in some cases.
Sex therapy with a qualified counselor may help erectile dysfunction resulting from:
- Ineffective sexual techniques.
- Relationship problems.
- Anxiety or depression.
To reduce your future chance of having erectile dysfunction:
- Take medications to manage your blood pressure and diabetes.
- Ask your doctor about changing medications
- Maintain a healthy weight and eat a healthful diet.
- If you smoke, quit. Smoking is significantly associated with erectile dysfunction in older men.
- If you have anxiety, stress, or emotional difficulty in your life, consider talking to a therapist or counselor.