The Next Step in Erectile Dysfunction Diagnosis

erectile dysfunction diagnosis

Take Your ED Problem to an Expert

So, you’ve read all about the symptoms and signs that can indicate erectile dysfunction. And you think you have an erectile problem. The next step is to consult with a doctor. This can determine how quickly it takes to get you back into action in the bedroom.

Who do I see about ED?

First off you need to visit your GP practice or local sexual health clinic. Sexual health clinics treat genital problems. They can provide the same treatment you would get at your GP surgery. Many sexual health clinics offer a walk-in service. So, you don’t need an appointment. They’ll often get test results quicker than GP practices.

You may be seen by a doctor or nurse. Alternatively, if you are willing to pay, you may make an appointment with a private specialist.

How Do You Talk to Your Doctor about ED

You’re not alone if you find the thought of talking to stranger about your intimate problems cringeworthy. A study published in The Journal of Sexual Medicine found that only 25% of men diagnosed with erectile dysfunction sought treatment. Embarrassment may well be the reason. However, it is important that you do seek diagnosis and treatment. Most erectile dysfunction is treatable. Treaments include medication, lifestyle changes and psychological therapies. But finding out which is best for you requires some talking. So, how best do you deal with a possibly awkward conversation?

Don’t Save Your ED Problem for the End

When many men visit their doctor they don’t bring up their erectile concerns. Similarly they raise these concerns in passing at the end of the consultation. Doctors, especially GP’s, are busy people. Also GP’s are only meant to deal with one issue during each ten minute appoitment. So bringing up something at the end of an appointment is a poor approach. For the reason that your doctor won’t have the time to address the problem as thoroughly as required. Consequently, your ED problem could get brushed aside as nothing to worry about. Alternativley, you may end up having to make a separate appointment. As a result, your ED remains untreated for longer and can only increase your anxiety.

Be Straightforward and Direct

When the doctor or nurse asks you the reason for your visit be honest and direct. Say something like “I’m having sexual health issues that I’d like to talk to you about”.

Give All the Details

Specific details can help your physican pinpoint what might be causing your bedroom issues.

Don’t just say that you are suffering from erectile dysfunction. Typcially, doctors frown upon self-diagnosis.

Tell the doctor if you can’t get an erection, if you can’t maintain an erection, or if you’re not getting a sufficiently hard enough erectiion for penetrative sex.

It’s important you tell you doctor if you’re experiencing any additional symptoms, even if you don’t think they’re related to ED. If you have been feelig depressed, tired or overly anxious, for example, then it is important that your doctor knows. Other underlying issues often can go alongside erectile dysfunction.

Be specific as possible when descibing the nature and frequency of your symptoms to your doctor. The more information you can give, the more likely it is that the doctor can get to the correct diagnosis and treatment plan at the earliest stage.

Give Honest Answeres

Having started the conversation, your doctor should start asking you questions about your history and lifestyle. He or she will want ot know if you’re a smoker, how healthily you eat, how much alcohol you drink and how much exercising you do.

When answering, telling the truth is important. Many cases of erectile dysfunction are linked to an unhealthy lifestyle. Hence, you shouldn’t shy away from this. It is good news in terms of treatment because your lifestyle is in your control. However, your doctor needs to know the truth to better treat your specific case.

It may be awkward but honesty up front means less time needed to figure out what’s going on.

Find Out About Other Options

Doctors and nurses aren’t perfect. If you are not happy with the consultation because he or she ignores your concerns or dismisses your issues out of hand then ask to be referred to a specialist. Similarly you should ask for a referral if your doctor is just plain uncomfortable discussing your problem. You need to ask to see a physcian who specialises in this field. This could be a urologist or primary care doctor with a special interest and expertise in sexual medicine.

Should You See a Specialist?

So, we’ve established that when your erections regularly fail, you need to see a professional. But which kind of professional is best equipped to help you?

Start with your General Practitioner

In most cases, your GP is a good place to start. He or she can start the diagnosis process and arrange tests to check for any related health conditions. GP’s may also prescribe first-line ED treatments. Unless there are contraindications or a reluctance to take pills, then the treatment is usually a PDE5 inhibitors e.g. Viagra, Cialis or Levitra.

The vast majority of GP’s are very comfortable discussing men’s sexual health with their patients. So there is need to feel embarrassed or uncomfortable talking about your problem.

When you should see a specialist

There are some circumstances where a specialist may be preferrable. However, in the UK, unless you are seeking a private consultation, you will still need to see your GP or visit a sexual health clinic and ask for a referral.

  • Your GP seems wary or hesitant. Most doctors are great at talking about erectile dysfunciton. But if your doctor seems to brush off your worries, you will want to ask for a referral to a specialist.
  • Your treatment doesn’t work. If the treatment your GP prescribes either doesn’t work for you or has stopped working for you, then it may be time visit a specialist.
  • You have other urological problems. If you have other urological concerns along with your impotence, such as difficulty urinating or prostate problems, you may want to see a specialist sooner rather than later.

What kind of specialist treats ED?

ED experts are usually urologists. Urologists are physicians who specialise in diseases of the urinary tract and the male reproductive system. However, not all urologists focus on erectile dysfunction. Some urologists place a greater emphasis on things like kidney stones, cancer or urinary problems. Unfortunately, if you are using the NHS then you probably won’t have a choice of expert. However, if you are seeking private treatment then it is worth finding a urologist or other expert practitioner who really focuses on ED.

What to Expect from Your Doctor’s Appointment

Having worked up the courage to make (and attend!) an appointment, here’s what to expect:

A Physical Examination

Your doctor or nurse should record your height, weight, and blood pressure. But you should also expect a comprehensive genit0-urinary examination. The practitioner should examine your penis and testes. He or she should also check your prostate arteries and your groin area for a good pulse. This is because a slow or low pulse is a signal that not enough blood is reaching the area to enable good erectile performance. Although you may find this examination uncomfortable, it should not be painful and is a necessary part of the appointment.

A History

For fast and accurate diagnosis it is importnat that you honestly answer your doctor’s questions about history and lifestyle. This is in your best interest.

Your practitioner may also use surveys, such as International Index of Erectile Function (IIEF) questionnaire or the Brief Male Sexual Function Inventory for Urology (BSFI). This is to a better understanding of the severity of the problem at hand and the most probable underlying causes.

The IIEF-5 questionnaire is availabe anonymously and online on our website. You are asked a series of five questions in which you rate how applicable each one is on a scale of 1 to 5. The lower the total score, the more severe your erectile dysfunction.

Your practioner may also ask some personal questions related to your problem. These questions may include:

  • For how long have you been experiencing the problem?
  • How much is the problem affecting your life?
  • How much is the problem affecting your partner’s life?
  • What, if any, lifestyle changes or treatments have you tried?

Waist Circumference and BMI

Research suggests that excessive body weight—measured through a higher Body Mass Index or BMI—is an independent risk factor for ED.

You can use this BMI Calculator to see where you fit.

A BMI over 25 puts you in the overweight category. Overweight men are at an increased risk for erectile dysfunction. In contrast, a BMI between 18.5 and 24.9 is considered healthy.

Visceral fat collected around abdomen and a large waist measurement are an even stronger indicator of the likelihood of ED. A sudy conducted by Cornell Univdersity in the States found that men with waist measurements larger than 40 inches were more likely to suffer from erectile dysfuntion than men with smaller waist sizes. This may be because low testosterone is a factor linked to erectile dysfunction. A large waist cirumference has been shown to be the strongest single indicateor of deficiency of testosterone. A large waist circumference is a marker for abdominal fat. And the enzyme aromatase, responsible for abdominal fat, can convert testosterone to the “female” hormone oestrogen.

Testosterone Test

Low levels of testosterone are commonly known as “low T”. Although low T may not be directly to blame for ED, testosterone does govern men’s libido and play a crucial part in erections. Even if low T is not directly linked to ED, it can be linked to other common risk factors for ED including obesity, diabetes, high cholesterol and heart disease.

Testosterone levels are somewhat controversial. Not all experts agree on the level that signals deficiency. Consequently, many GP’s, at least in the first instance, will not order a low T test. However, the test is readily available from private labs. Generally, a total testosterone reading of less than 300 nanograms per deciliter (ng/dL) indicates the need for further investigation.

Lipid Screening

As high total cholesterol (above 200 milligrams per deciliter (mg/dL)) is a risk factor for both erectile dysfunction and heart disease a cholesterol test is advisable. The test also measures “good” HDL cholesterol and “bad” LDL cholesterol. HDL cholesterol can help stop fatty build ups in the walls of your arteries. These buildups can slow down blood flow to the heart or penis causing heart disease or ED respectively. When looking at HDL cholesterol you want your level to be at least 40 mg/dL.

Fasting Plasma Glucose Test

Diabetes is one of the main risk factors for erectile dysfunction. And between 60 and 80 percent of men with diabetes develop ED. So, to rule out diabetes or a prediabetic condition, your practitioner should run what is called a fasting plasma glucose test. With this blood test readings of less than 100 mg/dL are considered normal,. However, a reading of between 100 and 125 mg/dL is considered prediabetes. A reading bove 126mg/dL  is considered diabetes.

Diabetes is associated with other risk factors for erectile dysfunction auch as obesity and increased abdominal fat. In addition, diabetes can damage the nerves and blood vessels important in maintaining an erection.

Although you may think that diabetes is an irreversible downward spiral, the good news is that type 2 diabetes can often be controlled through diet and exercise. In a recent study of 31 obese diabetic men decreased daily caloric intake by 600 calories a day and switched to a high-protein, low-carb diet. Not only did this regimen led to modest weight loss, but most participants found a fast improvement in sexual problems within just 8 weeks.

Additional Tests

In addition to standard tests and medical history, there are also more specific tests to diagnose erectile dysfunction. These tests are not necessary for all patients. Howver, specialists may sometimes use them to provide more clarity to their diagnosis.

  • Nocturnal Penile Tumescence Test. Healthy men generally have a few erections each night. However, the frequency, degree and length of erections may be decreased in men with ED. So, to test for this, you place a special ring-like device around your penis before you go to bed. The device measures and records how many erections you have, how long each erection is and how firm each is during the night. This information can help your doctor in identifying your underlying problems.
  • Urinalysis. A sample of your urine can be analysed for a range of disorders including urinary tract infections or diabetes. Any positive results can help your doctor to make a better diagnosis of what’s causing your erectile dysfunction.
  • Penile Biothesiometry. This painless test measures nerve sensation in the penis and testicles. A vibrating device is gently applied to your genital to measure your perception of the vibrations.
  • Ultrasound. Before perfoming an ultrasound of your penis and testicles your doctor will make an injection at the base of the penis to cause an erection. The injection can sting a little and please no jokes about “just a little prick”. Once your penis is erect the doctor uses a device called a transducer on the skin of your penis. This device detects blood flow in and out of your penis and helps him or her to spot any abnormalities.

BMI Calculator

content provided by NHS Choices