Clinical diagnostics of erectile dysfunction
Erectile dysfunction is a permanent or recurring incapacity to perform sexual intercourse and difficulties to have ejaculation.
Forms of erectile dysfunction
There are several types of erectile dysfunction:
Psychogenic factors account for about 30% of all cases of erectile dysfunction. Vascular forms are about 70% of cases of erectile dysfunction. Approximately 1/3 of the vascular cases of erectile dysfunction are associated with abnormal arterial function. 1/3 ED cases are associated with venous disturbances and 1/3 ED is associated with mixed arterial-venous forms.
For diagnosis of the type of erectile dysfunction, dopplerometry of the penis vessels, ultrasound of the prostate and scrotum, biochemical blood test (hormones, glucose, lipid spectrum, hepatic enzymes) has been widely used.
Collection of anamnesis in ED:
Before proceeding with the examination, the physician collects data concerning the overall health of the patient:
- The detection or elimination of diseases that could cause erectile dysfunction: diabetes, atherosclerosis, hypertension, kidney failure, smoking, alcohol abuse, mental and neurological diseases, dyslipidemia;
- Evaluation of results after the passage of drug therapy;
- Evaluation of the sexual function of men, while taking into account: severity and duration of sexual disorders; what causes sexual disorders; whether there is a night and morning erection; whether the attraction to the opposite sex has remained.
What are the effective ways of ED diagnostics?
Because of false shame and fear to hear a negative prognosis, only 10% of men, having noticed some erection violations, go to a doctor. During the examination, the presence or absence of nocturnal erections is established. They can be registered using a special sensor, which is fixed on the penis in the evening.
The doctor conducts a finger examination for the investigation of the innervation of the penis – normally, when the head of the organ is compressed, the anus decreases immediately.
Diagnosis of erectile dysfunction begins with standard questions that the patient must answer about the quality of current sexual life.
Since most of the cases of impotence are associated with organic disorders, the prostate is examined as well as the endocrine system to detect:
- Diabetes mellitus;
- Prolactinoma – a benign tumor of the anterior lobe of the pituitary gland;
- Hypogonadism – underdevelopment of the testes, tumors of the thyroid gland and the adrenal cortex.
Additional methods applied to diagnose ED:
- Dopplerography: it is a kind of ultrasound, when in the dynamics of the introduction of a drug that causes an erection, the symptoms of ED are revealed:
- Determine the blood flow in the cavernous bodies;
- Ultrasound of the penis;
- Check the presence of calcification sites in them;
- Measure the amount of venous outflow;
- Identify signs of atherosclerosis and vascular scarring;
- The arterial pressure in the organ is measured.
- Cavernography – X-ray contrast study provided for the examination of the venous system of the penis. Cavernography allows assess the condition of the venous system and cavernous bodies of the penis. It also is helpful to assess the structure of cavernous bodies and detection of foci of atrophy and sclerosis.
- Biotesiometry: it is a vibration test that can detect abnormalities of the penile innervation. If the sensitivity index is reduced, this may indicate the presence of disturbances in innervation. This condition can be observed in diabetes, neuropathy or aging of the body. If the sensitivity is increased, which most often happens at a young age, this may indicate premature ejaculation.