Erectile Dysfunction Diagnostic Protocol
Obtaining an accurate detailed history for the erectile dysfunction patient is essential in order to make an accurate diagnosis before planning treatment procedures. The initial step is a self-administered patient history questionnaire.
The completed questionnaire is reviewed with you by our doctors and additional questions may be raised in the consultation. Specific questions regarding erectile performance indicate your erectile dysfunction extent. A review of your history enables our doctors to determine if the nature of your issue is a physical condition or psychogenic, your current level of erectile functioning, which initial diagnostic tests will be the most useful and what treatment should begin immediately.
Genetic and lifestyle conditions as hypertension, hypercholesterolemia, cardiovascular disease and diabetes will be investigated. Any history of previous pelvic surgery (prostate, bladder, colorectal), radiation therapy or chemotherapy may be relevant to and discussed. You will be asked about medication intake, smoking, alcohol consumption or other drug use as these activities might also impact your erectile function.
In addition to a routine physical examination, further examination and prescription of diagnostic tests will depend on your age, general health and treatment goals.
There are several advanced diagnostic tests may be recommended in cases where a diagnosis remains unclear or if a surgical option is being considered. Most serve to confirm the presence and degree of a physical or other underlying issues leading to erectile dysfunction.
Blood, hormonal testing
An evaluation of your blood sugar, cholesterol, testosterone and other hormone levels may be utilised to rule out specific medical causes of erectile dysfunction. These tests can be performed in our clinic on the day of your first consultation or can be prescribed by our doctors for a later time convenient to you.
This test involves monitoring erections during your sleep. It has been long established that non affected men will experience a number of erections (3-5) during their night’s sleep. This test is particularly useful in younger patients where a diagnosis of psychogenic erectile dysfunction is suspected. If erections occur and are documented by the device, the patient’s ED is most likely psychogenic.
Penile injection and measurement analysis
This test is performed by injecting the base of the penis with medication such as alprostadil (Prostaglangin E-1). This very useful test allows the doctor to evaluate the capacity of your penis to achieve an erection and is also an indirect evaluation potential damage within the erectile tissues of the penis. The amount of medication required to obtain a maximal response is an indication of the severity of erectile dysfunction and helps determine whether you are likely to benefit from medical treatment or which option will be most successful. In addition, the doctor is able to examine your penis during an erection and note any abnormality such as plaques or curvature indicating Peyronie’s disease.
A duplex ultrasound identifies blood flow through your arteries and veins. It combines traditional ultrasound with doppler ultrasound. Traditional ultrasound uses sound waves that bounce off blood vessels to create images. Doppler ultrasound records sound waves reflecting off moving objects (example: blood cells), to measure their speed and other aspects of how they flow.
This procedure involves injection of erection inducing medication into your penis. The drugs cause dilation of the blood vessels causing an erection. Men with diseased blood vessels, potentially caused by high blood pressure, arteriosclerosis, diabetes, etc., will not be able to develop a full erection. Therefore, the test will tell us whether the erectile dysfunction has been caused to arterial vascular disease.
Moreover, this ultrasound technique allows our doctors to visualize the cavernosal arteries and muscle tissue, allowing for the detection of abnormalities such as fibrosis and calcifications of the erectile muscle.
The ultrasound examination can also detect the presence of a veno-occlusive dysfunction, which prevents trapping and storing blood in the penis sufficient to maintain an erection. Measuring the ratio of blood flow into the penis while the heart is pumping versus when it is at rest will assess this. This measurement is called the resistive index and is based on the observation that in a normal erect penis, the pressure inside the erectile chamber exceeds pressure in the arteries when the heart is at rest, therefore no blood should flowing into the penis. If blood flow occurs in this situation, the diagnosis of veno-occlusive dysfunction can be confirmed.
I am suffering from erectile dysfunction, what should I do next?
We advise you to book a consultation with one of our highly experienced doctors. The first step towards successful treatment is an accurate diagnosis of potential causes by our specialists.
After this, our doctors will seek to do two things:
- design a treatment plan that will allow you immediately to achieve a strong erection to continue normal sexual activities
- design a treatment plan to address the underlying causes of your erectile dysfunction. This means that each treatment we offer in our clinic is highly personalised.
While our doctor’s experience from over 30,000 erectile dysfunction patients allows us to create detailed treatment plans, a majority of doctors limit treatment options to medication, often leaving the underlying causes untreated. This can lead to a life-long dependence on drugs and in many cases, long term, unsuccessful treatment and your dissatisfaction.