Erectile Dysfunction Diagnostics and Treatment Methods

April 9, 2017 Category: Erectile Dysfunction

Erectile dysfunction diagnostics is based on:

  • anamnesis;
  • instrumental examination;
  • laboratory examination.

The collection of information facilitates adapted questionnaires use. The use of such forms makes it possible not only to smooth out feeling of embarrassment in conversation with shy patient, but also to save the doctor’s time.

Table: Test to Define Erectile Dysfunction Severity

How can you estimate

your confidence level,
that you are able to obtain and maintain erection?

Very Low

1

Low

2

Mild

3

High

4

Very High

5

In case of sexual stimulation, is your erection hard enought to penetrate into vagina??

Absence of sexual stimulation

0

Hardly ever and never

1

Rare (<50%)

2

Rare (≤50%)

3

Often (≥50%)

4

Almost always or always

5

How often are you able to maintain erection after penetration?

Do not try to carry out sexual intercourse

0

Hardly ever or never

1

Rare (<50%)

2

Rare (≤50%)

3

Often (≥50%)

4

Almost Always or always

5

During sexual intercourse, is it difficult for you to maintain erection?

Do not try to carry out sexual intercourse

0

Extraordinarily difficult

1

Very hard

2

Difficult

3

A little bit difficult

4

Simple

5

In attempts to carry out sexual intercourse how often you are satisfied?

Do not try to carry out sexual intercourse

0

Hardly ever or never

1

Rare (≤50%)

2

Rare (=50%)

3

Often (≥50%)

4

Almost always or always

5

Tests Results:

  • 5-7 points – severe ED – impotence;
  • 8-11 points – average ED severity;
  • 12-16 points – easy-medium degree;
  • 17-21 points – mild ED form;
  • 22-25 points – patient is healthy.


Diagnostics Methods

  1. Laboratory diagnosis includes: determination of hormonal male status, according to testimony, analyzes that exclude or confirm presence of somatic diseases (blood glucose, PSA, lipid spectrum, total cholesterol, HDL, LDL, general blood test, general urine analysis).
  2. In some cases, monitoring of nocturnal spontaneous erection is used. This method allows differential diagnosis of organic and psychogenic erectile dysfunction forms. So, with psychogenic ED, unlike organic, spontaneous nocturnal erection is preserved.
  3. ultrasonic doppler examination (USDG) of penile arteries allows to evaluate microcirculation, to reveal structural changes in cavernous fibrosis and Peyronie’s disease. USDG of penile arteries is more informative if it is performed in state of rest and erection followed by results comparison.
  4. The test with intracavernous introduction of vasoactive drugs allows to reveal vasculogenic ED. With normal arterial and veno-occlusive hemodynamics 10 minutes after injection there is pronounced erection that persists for 30 minutes or more.

Other Diagnostics Methods of Erectile Dysfunction

  • cavernosometry (determination of volumetric velocity of physiological solution injected into cavernous bodies necessary for erection appearance) is the main test directly assessing degree of sinusoidal system elasticity disturbance and its closing ability;
  • cavernosography (demonstrates venous vessels, through which blood shunt from cavernous bodies predominantly takes place);
  • radioisotopic phalloscintigraphy (allows to estimate qualitative and quantitative indicators of regional hemodynamics in penile cavernous bodies);
  • neurophysiological studies, in particular, definition of bulbocavernous reflex in patients with diabetes mellitus, with spinal cord damage.

Erectile Dysfunction and Impotence Treatment

  • Inhibitors of phosphodiesterase type 5 (Viagra, Levitra, Cialis). Contraindication for appointment of drugs of this group is reception of patients with nitric oxide or nitrate donors in any dosage form.
  • Substitutional hormone therapy. If disease is caused by hormonal disorders, it is necessary to restore normal hormonal status. To date, there are convenient dosage forms that allow you to adjust level of testosterone (male sex hormone).
  • Another method of treatment is vacuum therapy using pump for penis. Vacuum device is arranged quite simply – it consists of tube, which is connected to pump. You put penis in tube and pump out air from tube. As a result, vacuum forms, which stimulates blood flow to penis.
  • If erectile dysfunction treatment is not successful, or if patient can not for any reason take PDE5 inhibitors or use vacuum device, drug called Alprostadil can be prescribed. Alprostadil helps to improve blood flow to penis. Injection of alprostadil can be done directly into penis or small pill (urethral clamp) can be placed in urethra.
  • Psychotherapy (sex therapy). If ED cause lies in field of psychology, patient needs psychotherapist’s help. Sex therapy is form of psychotherapy, when you and your partner can discuss any issues related to sexual life, emotional problems that can contribute to erectile dysfunction development. The therapist can also provide you with practical recommendations on issues such as ways of erotic stimulation before intercourse and advise which other effective therapies can be applied to improve your sexual life.
  • Cognitive behavioral therapy is another type of psychological counseling that can be useful in this disease. The basis of this method is the following principle: what we feel depends to large extent on how we think about it. Consequently, harmful thoughts and unrealistic views can seriously affect your self-esteem, sexuality, and your relationships with loved ones and contribute to erectile dysfunction development. In this situation, psychotherapist who engages in cognitive behavioral therapy will help you get rid of such thoughts and ideas and develop correct and realistic attitude to yourself and your sexuality.