What is the initial workup for erectile dysfunction?

From the Guidelines

The initial workup for erectile dysfunction (ED) should begin with a comprehensive medical history and physical examination, focusing on identifying underlying causes and modifying risk factors, as recommended by the most recent and highest quality study 1. The initial workup for ED should include discussing the patient's sexual history, onset and duration of symptoms, presence of morning or nighttime erections, and any associated medical conditions. A thorough review of medications is essential as many drugs can contribute to ED, including antihypertensives, antidepressants, and antiandrogens.

Key Components of Initial Workup

• Laboratory testing should include fasting glucose or HbA1c to screen for diabetes, lipid profile to assess cardiovascular risk, and morning total testosterone to evaluate for hypogonadism, as suggested by 1.
• Additional tests may include thyroid function tests, prolactin levels, and PSA screening when appropriate.
• A focused physical exam should assess secondary sex characteristics, genital anatomy, and vascular and neurological systems.
• Specialized tests like nocturnal penile tumescence testing or penile Doppler ultrasound are typically reserved for complex cases, as noted in 1.

Importance of Risk Factor Modification

Modifying risk factors, such as smoking cessation, weight loss, increasing physical activity, and avoiding excess alcohol consumption, is crucial in the management of ED, as emphasized by 1.

Comprehensive Approach

This comprehensive approach helps identify underlying causes of ED, which may include vascular disease, neurological disorders, hormonal imbalances, medication side effects, or psychological factors. Early identification of conditions like diabetes or cardiovascular disease is particularly important as ED can be an early marker of systemic vascular disease, potentially preceding cardiac events by 3-5 years, highlighting the importance of a thorough initial workup, as discussed in 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Initial Workup for Erectile Dysfunction

The initial workup for erectile dysfunction (ED) typically involves a combination of medical history, physical examination, and laboratory tests.

• A detailed medical, sexual, and psychosocial history is crucial in diagnosing ED, as it helps identify potential underlying causes and differentiate between physical and psychogenic causes 2.
• Physical examinations may not always be necessary but can be helpful in identifying signs of underlying conditions such as Peyronie's disease and hypogonadism 2.
• Laboratory tests that are usually part of the initial workup include:
  • Fasting serum glucose level to screen for diabetes 3, 2
  • Lipid panel to assess for hyperlipidemia 3, 2
  • Thyroid-stimulating hormone test to evaluate thyroid function 3
  • Morning total testosterone level to check for hypogonadism 3, 2

Specialized Investigations

While not part of the routine initial workup, specialized investigations such as ultrasound, nocturnal penile tumescence and rigidity assessment, and color Doppler flow studies of the penile vasculature may be considered in certain cases to further evaluate the cause of ED 2, 4.

Importance of Comprehensive Evaluation

A comprehensive evaluation is essential for the effective management of ED, as it allows for the identification of underlying causes and the selection of appropriate treatment options 5, 6. This evaluation should consider the complex interplay between vascular, neurologic, hormonal, and psychologic factors that contribute to ED 6.