Erectile Dysfunction: Diagnosis and Treatment

Erectile dysfunction is characterized by the inability to gain or sustain an erection, and it happens to men of all ages. While the inability to get an erection, or a weak erection, is normal when it happens occasionally, when it becomes a repeat issue that impacts your sex life or relationships it may be an indication of erectile dysfunction. 

If you're concerned about your own ability or inability to get an erection, it's important to seek professional medical advice. During a medical consult, a clinician can help assess whether or not the issue warrants treatment.

A medical professional can help guide you to the option that will likely yield the best results for your situation. Still, it's a sensitive issue, and it can be disconcerting heading into a doctor’s visit not knowing what to expect. Below is a look at how erectile dysfunction is often diagnosed and treated. This article is meant to give you an idea of what to expect and is not intended to supplement medical expertise. These diagnosis techniques and treatments are best used under the guidance and professional expertise of a medical professional. 

Diagnosis

Men's sexual response is complex due to the many physical systems that need to work together to get an erection. ED causes can include psychogenic, vasculogenic, metabolic, hormonal, and neurogenic factors. Because of these many factors, the diagnosis of erectile dysfunction is somewhat involved. 

Unlike a condition like high blood pressure which can be diagnosed by simply taking a blood pressure measurement, erectile dysfunction can have one or more factors that contribute. Further, erectile dysfunction can present in a variety of ways: some men can get fully hard, but not for long, while other guys can't get en erection at all; for others yet, it's not every time they try for intimacy.

Below is a more detailed look at the multifaceted ways that ED is diagnosed and some of the tools that physicians use to assess a patient's situation and potential solutions. 

Sexual Health Inventory for Men

ED is a sensitive issue, and no guy wants to talk about it if they can avoid it. One challenge that physicians face with patients is that they sometimes may feel the need to avoid telling the full truth with their healthcare provider to avoid judgement. 

In reality this lack of transparency can result in a less-than-ideal diagnosis and treatment. The issue can be exacerbated when the topic revolves around such a sensitive topic like sexual health. 

To remedy this, many physicians may choose to administer a validated questionnaire to determine indications of a medical condition. For erectile dysfunction a medical professional may choose to administer the Sexual Health Inventory for Men (SHIM). The SHIM consists of 5 questions that have responses on a sliding scale. An example of one of the questions is as follows:

How do you rate your confidence that you could get and keep an erection?

1. Very low       2. Low       3. Moderate       4. High       5. Very high

The scores for each question are added up at the end and the total score is correlated with the likelihood an individual has a certain severity of ED. This questionnaire, while helpful, is not necessarily the sole means of diagnosing. It represents one tool that the physician can utilize to delve deeper into diagnosis and assessment. 

Mental Health Inventory

A unique aspect of the sexual response cycle is that while it's largely a biological response, your mental state and perception can have a direct impact on the ability to attain an erection. This represents how psychogenic factors can affect the sexual response and ability to gain an erection. 

Much like asking questions about your sexual health, physicians may find that their patients are more truthful when discussing their mental state. There are societal pressures for people to avoid showing mental distress, and because of this, many psychological assessments are provided through a questionnaire. 

Due to the possibility of psychogenic contributors to erectile dysfunction, a physician may choose to administer a validated mental health questionnaire like the Mental Health Inventory (MHI). The Mental Health Inventory comes in a multitude of forms with length ranging from 5 to 38 questions. The inventory is used as a tool for physicians to help determine if a patient is experiencing mental distress. This questionnaire in the context of ED is mainly utilized in conjunction to talking with the patient to determine if stress or anxiety are contributing factors to erectile dysfunction. Both are common causes, and working out whether the symptoms of ED are mental or physical is a key step in diagnosing ED.

Medical History

Medical history is an important component to any diagnosis for a medical professional. Assessing your medical history is an opportunity for physicians to get a better picture of your circumstance and what else may be going on. During the medical history, a physician will ask questions like current medications, family history of disease, and any other pertinent information. 

Understanding your medical history is important as a diagnosing physician because your background represents the bread crumbs that may lead to the cause of your ED. Medical conditions that affect blood flow and proper cardiovascular function are known to contribute to ED, including hypertension (high blood pressure), diabetes, obesity, and more. For many men, these issues are a root cause of ED, and addressing these underlying issues can lead to relief.

Many medications can be causative agents of erectile dysfunction, too. For example, a history of high blood pressure might suggest that your physician take a closer look at prescribed blood pressure medications and determine if a medication itself may be to blame. 

Your medical history is also vital in directing what treatment options are appropriate. For a prescription of erectile dysfunction medication like Viagra®, Cialis®, or Levitra® – all in the class of drugs called PDE5 inhibitors – it's important to ensure that a patient isn't taking any other nitrate based medications, like nitroglycerine for chest pain. If they do take these medications, the provider may need to offer an alternative treatment for either the ED or chest pain. 

Sexual History

Discussing sexual history can be uncomfortable, however it's incredibly important in the medical assessment of ED. Erectile dysfunction affects the penis and, as such, your sexual history can have a direct impact on diagnosis. The transmission of a sexually transmitted disease (STD) is a common occurrence and could be a potential factor in erectile dysfunction. 

By asking about your sexual history a physician can determine if a lab test is warranted to assess STD risk, and if it's a contributing factor to your ED. It's important to be truthful during these discussions because untreated STDs can lead to further health complications that can prolong or worsen your ED, like an infection of the prostate. Physicians are required by law to protect your privacy. Any conversations revolving around sexual history are confidential and are not shared with anyone. 

The Health Insurance Portability and Accountability Act of 1996 is a law that protects sensitive healthcare information of patients and poses hefty penalties against those that are in breach. This law allows you to rest assured knowing that your private information stays private. Knowing about HIPPA can allow you to be more open with your physician and ultimately allow your physician to provide the best care possible. 

Treatment

Twenty years ago there were very few, if any, treatment options available to men with ED. Today there are a plethora of options available. With so many options, a physician can help guide you to the right treatment option for you and your given circumstance. Below are four possible treatment options for ED. 

Lifestyle Modifications

One leading factor in erectile dysfunction is poor diet and living a sedentary lifestyle. Both of these actions (or inactions) can lead to a decrease in circulatory and cardiovascular ability, and vasculogenic erectile dysfunction can develop. The penis needs a steady supply of blood, and if your circulatory health is suboptimal, it can lead to ED. 

In the case that ED is due to lifestyle choices, a physician may recommend making healthy lifestyle modifications like monitoring food intake, diet, as well as more physical exercise. They may also recommend cutting back on alcohol, and unequivocally advocate for quitting smoking; both are known risk factors for developing ED. All of these can improve vascular health and result in a reduction of ED symptoms. 

Medications

Erectile dysfunction medications are a great option for those looking to get their sex lives back as soon as possible. Viagra (sildenafil), Cialis (tadalafil), and Levitra (vardenafil) are all prescription medications that can help men with ED achieve an erection. 

Rex MD is a simple resource for determining if medication is right for you. Our telemedicine platform lets guys access a licensed clinician from home for prescription ED meds, if appropriate, and all done online. We then have your medications shipped directly to your door, providing further privacy and discretion. 

Assistive Devices

In cases where medications are not viable due to your health situation, a physician may recommend utilizing an assistive device like a penis pump or penis ring. 

Penis pumps work by placing a vacuum chamber around the shaft to increase blood accumulation in the penis. A penis ring works to help maintain an erection through the restriction of outbound blood flow from the penis typically responsible for the reduction of an erection. Sometimes these devices are used in combination.

Surgery

When an individual does not want to deal with medications or devices, surgery is also a viable option. A surgical ED procedure generally involves the addition of an inflatable implant to the shaft and the placement of a reservoir within the scrotum. This allows for the patient to attain an erection at any time and can be an option for those that haven't found success with medication or other options. 

The Takeaway

The diagnosis and treatment of ED is not always clear cut and simple, but a good clinician will understand the ideal tools to use in assessing your symptoms. Diagnosis requires a holistic assessment of an individual as well as a personalized care plan to provide the best outcomes. 

A licensed clinician like those at Rex MD are qualified and ready to help you navigate the complexities of ED – all from the comfort of home. Click here to get started with an assessment of your own today.

SOURCES

Current diagnosis and management of erectile dysfunction -- Medical Journal of Australia

Sexual Health Inventory for Men (SHIM) -- PfizerPro

Mental Health Inventory: Sensitivity and Specificity of the Portuguese Version of the MHI-38 and MHI-5 -- Sage Journals

HIPAA - Health Information Privacy -- Human Health Services