Diagnosis of Erectile Dysfunction

How do doctors diagnose erectile dysfunction?

A doctor, such as a urologist, diagnoses erectile dysfunction (ED) with a medical and sexual history, and a mental health and physical exam. You may find it difficult to talk with a health care professional about ED. However, remember that a healthy sex life is part of a healthy life. The more your doctor knows about you, the more likely he or she can help treat your condition.

Medical and sexual history

Taking a medical and sexual history is one of the first things a doctor will do to help diagnose ED. He or she will ask you to provide information, such as

• how you would rate your confidence that you can get and keep an erection
• how often your penis is firm enough for intercourse when you have erections from sexual stimulation
• how often you are able to maintain an erection during sexual intercourse
• how often you find sexual intercourse satisfying
• if you have an erection when you wake up in the morning
• how you would rate your level of sexual desire
• how often you’re able to climax, or orgasm, and ejaculate
• any surgeries or treatments that may have damaged your nerves or blood vessels near the penis
• any prescription or over-the-counter medicines you take
• if you use illegal drugs, drink alcohol, or smoke

This information will help your doctor understand your ED problem. The medical history can reveal diseases and treatments that lead to ED. Reviewing your sexual activity can help your doctor diagnose problems with sexual desire, erection, climax, or ejaculation.

Mental health and physical exam

A health care professional may ask you some personal questions and use a questionnaire to help diagnose any psychological or emotional issues that may be leading to ED. The health care professional may also ask your sexual partner questions about your relationship and how it may affect your ED.

He or she also will perform a physical exam to help diagnose the causes of ED. During the physical exam, a health care professional most often checks your

• penis to find out if it’s sensitive to touch. If the penis lacks sensitivity, a problem in the nervous system may be the cause.
• penis’s appearance for the source of the problem. For example, Peyronie’s disease causes the penis to bend or curve when erect.
• body for extra hair or breast enlargement, which can point to hormonal problems.
• blood pressure.
• pulse in your wrist and ankles to see if you have a problem with circulation.

Lab tests

Blood tests can uncover possible causes of ED, such as diabetes, atherosclerosis, chronic kidney disease, and hormonal problems.

Imaging tests

A technician most often performs a Doppler ultrasound in a doctor’s office or an outpatient center. The ultrasound can detect poor blood flow through your penis. The technician passes a handheld device lightly over your penis to measure blood flow. Color images on a computer screen show the speed and direction blood is flowing through a blood vessel. A radiologist or urologist interprets the images. During this exam, a health care professional may inject medicine into your penis to create an erection.

Other tests

Nocturnal erection test. During a nocturnal, or nighttime, erection test, you wear a plastic, ring-like device around your penis to test whether you have erections during the night while you sleep. This test usually takes place at home or in a special sleep lab. A more involved version of this test uses an electronic monitoring device that will record how firm the erections are, the number of erections, and how long they last.

Each night during deep sleep, a man normally has three to five erections. If you have erections during either type of test, it shows that you are physically able to have an erection and that the cause of your ED is more likely a psychological or emotional issue. If you do not have an erection during either test, your ED is more likely due to a physical cause.

Injection test. During an injection test, also called intracavernosal injection, a health care professional will inject a medicine into your penis to cause an erection. In some cases, a health care professional may insert the medicine into your urethra instead. The health care professional will evaluate how full your penis becomes and how long your erection lasts. Either test helps the health care professional find the cause for your ED. The tests most often take place in a health care professional’s office.