Impotence Tests
By admin at 12 February, 2009, 11:48 pm
Patient History
A diagnosis of erectile dysfunction is made in men who have repeated inability to achieve and/or sustain an erection while receiving sexual stimulus for at least 3 months. It is very important, as the patient, to always be up front and honest with your doctor so that a correct diagnosis can be made. Not being candid with your doctor will do you more harm than it will good. Honest answers tend to allow doctors to better diagnose the onset of erectile dysfunction, assess its severity, and determine the cause. During patient interview, please be sure to try to answer the following questions:
1. Is the patient suffering from erectile dysfunction, from a loss of libido, or a disorder affecting the ability to ejaculate?
2. Is the ED attributed to psychological or physical factors? Healthy men normally have involuntary erections (something called “morning wood”) in the early morning and during REM sleep (a stage in the sleep cycle with rapid eye movements). Men with psychogenic erectile dysfunction (erectile dysfunction caused by psychological factors such as stress and anxiety and not by physical factors) usually maintain these involuntary erections. Men with erectile dysfunctions due to some physical factor (for example: atherosclerosis, smoking, and diabetes) usually do not have these involuntary erections.
3. Are there physical factors causing the erectile dysfunction? A prior history of cigarette smoking, heart attacks, strokes, and poor circulation in the extremities suggests atherosclerosis as the cause of the erectile dysfunction. Diminished sensation of the penis and the testicles, bladder dysfunction, and decreased sweating in the lower extremities point to some type of diabetic nerve damage. Loss of the “sex drive”, lack of sexual fantasies, gynecomastia (enlargement of breasts), and diminished facial hair suggest low testosterone levels.
4. Do medications the patient is currently taking contribute or correlate to the problem of erectile dysfunction?
Physical Examination
Physical examinations are the best means to reveal any physical abnormalities that may be causing the erectile dysfunction. For example, a lack of response by the penis physical contact could point to a problem in the nervous system. Or, small testicles, a lack of facial hair, and enlarged breasts could be the result of something known as hypogonadism, which is when the body produces less testosterone than is actually needed.
An examination of the legs or listening by means of a stethoscope for bruits (the sound of blood flow as it passes through narrowed arteries) can indicate a reduced blood flow most often caused by atherosclerosis. Also, a physical check-up of the penis itself can sometimes show a problem in itself. If any unusual characteristics are noticed, such as being able to be bent during an erection (Peyronie’s disease), it could indicate some sort of erectile dysfunction in the subject.
Laboratory tests
Common laboratory tests used to evaluate erectile dysfunction:
• Complete blood counts
• Urinalysis: An abnormal urinalysis may be a sign of diabetes mellitus and kidney damage
• Lipid profile: High levels of LDL cholesterol (bad cholesterol) in the blood can cause atherosclerosis
• Blood glucose levels: Unusually high blood glucose levels may be a sign of diabetes mellitus
• Blood Hemoglobin A 1c: Unusually high levels of blood hemoglobin A 1c in patients with diabetes mellitus can indicate a poor control of blood glucose levels
• Serum creatinine: An serum known as creatinine may be the result of kidney damage due to diabetes
• Total testosterone levels: Blood samples for total testosterone levels should be taken early in the morning (before 8 am) because of the wide differences in testosterone levels throughout the day. A low total testosterone level could point to hypogonadism. The measurement of bio-available testosterone may be a better measurement than total testosterone, especially in obese men and men with liver disease; however, a measurement of bio-available testosterone is not widely available. Please consult a doctor and ask him or her for the best method for you
• PSA levels: PSA (prostate specific antigen) blood levels and prostate examination to exclude prostate cancer is important before starting testosterone treatment since testosterone can aggravate prostate cancer and cause the symptoms to worsen
Other Tests
The monitoring of erections as they occur during the patient’s sleep (nocturnal penile tumescence) can help distinguish between an erectile dysfunction of a psychological nature and those caused by some physical aspect. If nocturnal erections do not occur, the cause of erectile dysfunction is likely to be physical rather than psychological. However, tests of nocturnal erections are not completely reliable due to not being able to have a standardized test for all patients to determine what they are thinking about when sleeping. Over the years, scientists have tried to make a standard test, but have simply been unable to determine what characteristics should be the base to be applied to all patients as there are so many variables to be considered. In any case, this test has not proven very reliable and the other tests, as written above, should be the first option.
Psycho-social Examination
A psycho-social examination, consisting of an interview and questionnaire, may reveal psychological factors contributing to erectile dysfunction. The sexual partner may also be interviewed to determine expectations and perceptions encountered during sexual intercourse. Just as with the nocturnal erections test, this test is often difficult in providing doctors with a specific diagnosis as it is often difficult to get the truth out of their patients. Should you be asked any questions by your doctor please answer them fully and honestly. They are here for you and want to help you.
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