What examinations are needed to diagnose erectile dysfunction (sexual weakness)?

From the Guidelines

I strongly recommend consulting a healthcare provider, such as a primary care physician or urologist, to address sexual weakness concerns, as they will conduct a comprehensive evaluation including a detailed medical history, physical examination, and possibly blood tests to check hormone levels, blood sugar, and cholesterol 1. To address sexual weakness, the following examinations and tests may be necessary:

• A detailed medical history to identify underlying conditions that may be contributing to sexual dysfunction
• Physical examination, including blood pressure and examination of the genitalia 1
• Blood tests to check hormone levels, particularly testosterone, as well as blood sugar and cholesterol levels
• Additional tests, such as a nocturnal penile tumescence test to assess nighttime erections or vascular studies like Doppler ultrasound if blood flow issues are suspected
• Screening for underlying conditions like diabetes, heart disease, or hypertension that can contribute to sexual dysfunction
• Psychological evaluation to discuss stress, anxiety, depression, or relationship issues that may be contributing to sexual weakness Treatment options will depend on the specific cause of sexual weakness and may include:
• Lifestyle modifications, such as exercise, weight management, and reducing alcohol consumption
• Medications like PDE5 inhibitors, such as sildenafil or tadalafil 1
• Hormone replacement therapy if hormone levels are low
• Counseling to address psychological factors contributing to sexual weakness It is essential to be honest with your healthcare provider about your symptoms, medical history, and lifestyle habits to determine the most appropriate treatment approach for your situation.

From the Research

Examinations for Sexual Weakness

To diagnose and manage sexual weakness, also known as erectile dysfunction (ED), several examinations and tests are recommended. These include:

• A full medical and personally and culturally sensitive sexual history 2, 3, 4
• A focused clinical examination 2, 3
• Laboratory tests, such as:
  • Fasting glucose levels 2, 3, 5
  • Fasting lipid profile 2, 3, 5
  • Total testosterone level 2, 3, 5
  • Prostate-specific antigen test 2, 3, 5
  • Thyroid-stimulating hormone test 3, 5
  • Hemoglobin A(Ic) and total serum cholesterol levels 5
  • Hemoglobin and creatinine levels 5
• Psychological evaluation and counseling 6, 4
• Adjunctive testing, such as penile arterial revascularisation and venous ligation surgery, may be considered in select cases 2

Importance of Comprehensive Evaluation

A comprehensive approach to the evaluation of ED is warranted, as it may involve both psychological and organic components 6. The updated process of care model for evaluation of ED focuses on the combination of first-line pharmacotherapy and counseling, considering patient sexual dynamics 6. A detailed sexual history is the cornerstone for all sexual problem assessments and sexual dysfunction diagnoses 4.

Laboratory Evaluations

Laboratory evaluations can help identify risk factors that may benefit from lifestyle modification and pharmacological intervention 5. An evidence-based approach to standardization of laboratory evaluations for men presenting with ED is recommended 5. The prevalence of laboratory abnormalities in men with ED can be high, with common findings including low testosterone, increased prolactin, and abnormal luteinizing hormone levels 5.