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Testing for diagnosis of erectile dysfunction

Our primary mission as Circulation Specialists is to help you achieve the healthiest circulation possible for your stage in life.

Whatever your lifestyle, genetic predisposition or individual health aspirations – Your Circulation is your Lifeline.

What Is Erectile Dysfunction?

Erectile Dysfunction (ED), often referred to as impotence, is a condition in which a man finds it difficult to achieve or maintain an erection sufficient for sexual intercourse. Over 60-70% of these are caused by circulatory problems to the pelvis and penis, from poor blood flow to the organ via its arteries, or a too quick a drainage of blood from the organ via its veins.

Persistent erectile dysfunction can be a sign of physical or psychological health issues or both, necessitating a thorough evaluation and diagnosis. It can also be a silent marker for heart disease, and can pre-date a potential heart attack by 2.5 years or so.

Diagnostic testing is vital in this process, helping healthcare professionals identify specific factors contributing to ED and facilitating targeted interventions.

Diagnostic Testing for Erectile Dysfunction

The diagnosis of ED begins with a comprehensive evaluation process, commencing with an in-depth review of the patient’s medical history and a thorough physical examination. A Sexual Health Inventory for Men (SHIM) score is recorded to grade the severity of the condition and monitor improvement after treatment.

Subsequent testing, precisely chosen based on initial findings, further elucidates the specific causes of ED.

Initial Evaluation

The initial evaluation involves a detailed discussion about the patient’s sexual health, medical history including medication, and any symptoms experienced. Medical specialists may ask questions regarding the frequency, quality, and duration of erections, as well as the presence of factors that may contribute to ED, such as smoking, alcohol use, or the use of certain medications.

Laboratory Tests

Laboratory testing provides information into systemic conditions that might contribute to or exacerbate ED.

Blood Tests

Blood tests play a key role in diagnosing underlying conditions. Key parameters include:

  • Glucose Levels: Elevated blood sugar can indicate diabetes, a significant risk factor for ED.
  • Lipid Profile: High levels of low-density lipoprotein (LDL) cholesterol or low levels of high-density lipoprotein (HDL) cholesterol can signal cardiovascular problems, affecting erectile function.
  • Testosterone Levels: Low testosterone levels can directly impact sexual function and libido.
  • Other sex hormone levels: Levels of female sex hormones like Oestrogen and Prolactin may be raised causing erectile dysfunction and indicate disease elsewhere in a man.
  • Thyroid Function Tests: Abnormal thyroid hormone levels can influence energy levels, mood, and sexual function.
Urine Tests

A comprehensive urinalysis can help identify diabetes and other underlying health conditions not evident in blood tests alone.

Additional Blood Tests

Depending on the person’s health profile and risk factors, medical specialists might also recommend tests for prolactin, liver and kidney function, or other hormones related to the endocrine system.

Specialised Testing Methods

For certain cases of ED where the initial evaluation and laboratory tests do not provide a clear diagnosis, specialised testing methods can offer further insights.

Nocturnal Penile Tumescence (NPT) Test

The NPT test, also known as the sleep penile tumescence test, measures a man’s ability to achieve and maintain an erection during sleep. Normal nocturnal erections indicate that physiological mechanisms are intact, suggesting that ED may have psychological causes. This is rarely done in modern clinical practice.

Penile Doppler Ultrasound

Penile Doppler Ultrasound is a non-invasive test that uses high-frequency sound waves to visualise the blood vessels of the penis. This test is often performed in conjunction with an intracavernosal injection to evaluate blood flow dynamics and vascular integrity. However, this test is very observer dependent, and there can be significant variation in results between different sonographers/ radiologists.

Dynamic Infusion Cavernosometry and Cavernosography (DICC)

DICC tests are more invasive and are used to assess venous leak severity. In this condition, there is an inability to maintain an erection due to blood leaking out of the penis.

Erectile Dysfunction Hemodynamic (EDHD) testing

EDHD testing is the most comprehensive and reproducible test for vascular causes of ED. It studies blood flow velocities and pressures in all 4 arteries in the penis and compares them to the blood pressure in the arm and thumb. It can identify blockages in the arteries supplying the penis, the health of arteries within the penis, problems with blood leaking out of the penis (Venous leak ED, seen in younger men), the ageing male as well as psychological and medication related ED. This is our preferred method of testing.

Psychological Assessment

A psychological assessment is an integral part of the diagnostic process for ED, especially when no apparent physical cause is identified through laboratory tests or specialised testing methods.

The assessment involves a detailed discussion with a mental health professional, who may explore the following:

Psychological Factors

Stress, anxiety, depression, and other mental health issues can significantly impact erectile function.

Relationship Dynamics

The quality of the patient’s intimate relationships can influence ED. Communication problems, emotional disconnection, or sexual compatibility may be explored.

Sexual History

A thorough review of the patient’s sexual experiences, including any history of sexual trauma, abuse, or other significant events, can provide insights into potential psychological barriers to erectile function.

Lifestyle and Behavioural Factors

Daily habits, especially late and disturbed sleeping patterns, stressors, and coping mechanisms for stress and anxiety are also considered, as these can affect both mental and physical health.

Interpreting Test Results

Interpreting the results of diagnostic tests for ED is a nuanced process that requires a comprehensive understanding of the various factors that can contribute to the condition.

  • Correlating Findings with Symptoms
    This involves reviewing the outcomes of physical examinations, laboratory tests, specialised tests, and psychological assessments in the context of the patient’s reported experiences.
  • Identifying Underlying Causes
    The primary goal of test interpretation is to identify the root causes of ED. For instance, abnormal results in blood tests may indicate diabetes or cardiovascular disease, both of which can lead to ED.
  • Formulating a Treatment Plan
    Once the underlying causes are identified, the medical specialist can formulate a targeted treatment plan. This might involve managing existing health conditions including underlying heart disease and diabetes, lifestyle changes, psychological interventions, or specific treatments for ED.
  • Ongoing Monitoring and Adjustment
    Response to treatment should be evaluated periodically, and further testing may be necessary if symptoms persist or the patient’s health status changes.

Frequently Asked Questions (FAQs)

Can lifestyle changes improve erectile dysfunction?

Yes, modifications such as maintaining a healthy weight, regular sleep patterns, exercising regularly, quitting smoking, reducing alcohol consumption, and managing stress can improve ED.

Is erectile dysfunction always a permanent condition?

ED can be a temporary issue caused by factors like stress, fatigue, or alcohol consumption. In many cases, it is treatable and reversible, depending on the underlying cause.

How quickly can erectile dysfunction be diagnosed?

The duration of the diagnostic process varies depending on the case’s complexity, the tests required, and the person’s health status. Initial evaluations may provide immediate insights, but tests and follow-up assessments can extend the diagnosis timeline.

Can medications for other conditions cause erectile dysfunction?

Certain medications, including antidepressants, antihypertensives, and ulcer medications, can have side effects that contribute to ED. Discussing these medications with a medical specialist and switching in some cases to alternative medications, can help in managing this issue.

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