Key History Questions for Erectile Dysfunction Evaluation
A detailed medical history is the most important aspect of evaluating a patient with erectile dysfunction, focusing on identifying both organic and psychogenic causes that may affect morbidity and mortality.
Core History Questions
Description of the Problem
- Ask the patient to describe the problem in his own words
- Determine onset (sudden vs. gradual)
- Establish chronology and severity of symptoms
- Clarify if the issue is truly erectile dysfunction or another sexual problem (e.g., premature ejaculation)
Erectile Function Assessment
- Quality of erections (firmness, duration)
- Presence of morning/nocturnal erections
- Ability to achieve erection with self-stimulation
- Pattern of ED (situational vs. consistent)
- Ability to insert penis into partner's vagina
- Ability to maintain erection until completion of intercourse
Medical History
Cardiovascular risk factors 1:
- Hypertension
- Hyperlipidemia
- Diabetes mellitus
- Smoking status
- Exercise capacity (can patient walk 1 mile in 20 minutes?)
- Family history of cardiovascular disease
Other relevant conditions 2:
- Endocrine disorders
- Neurological conditions
- Obesity
- Depression or anxiety
- Alcoholism
- Sleep disorders
Surgical/Trauma History
- Previous pelvic, perineal, or penile surgery
- Radiation therapy to pelvis
- History of trauma to genitals, pelvis, or spine
Medication and Substance Use
- Current prescription medications
- Over-the-counter medications
- Recreational drug use
- Alcohol consumption patterns
- Tobacco use history
- Body-building supplements or steroids
Psychosocial Assessment
- Relationship status and quality
- Recent major life events or stressors
- Psychological problems (anxiety, depression)
- Partner's sexual function and health
- Sexual orientation and preferences
- Expectations regarding treatment
Distinguishing Psychogenic vs. Organic Causes
Suggestive of Psychogenic Origin 2
- Sudden onset
- Early collapse of erection
- Good quality spontaneous, self-stimulated, or waking erections
- Premature ejaculation or inability to ejaculate
- Problems or changes in relationship
- Major life events
- Psychological problems
Suggestive of Organic Origin 2
- Gradual onset
- Lack of tumescence
- Normal ejaculation
- Risk factors in medical history (cardiovascular, endocrine, neurological)
- Operations, radiotherapy, or trauma to pelvis or scrotum
- Current medications known to cause ED
- Smoking, high alcohol consumption, recreational drugs
Special Considerations
- In younger men (<40 years), while psychogenic causes are more common, at least 15-20% have organic causes that require thorough evaluation 1
- ED can be an early marker of cardiovascular disease, making cardiovascular risk assessment essential 1
- Common pitfalls include assuming ED in young men is purely psychogenic and overlooking ED as a marker for underlying cardiovascular disease 1
A thorough history-taking approach allows for proper identification of underlying causes of ED, which is essential for determining appropriate treatment and potentially identifying serious health conditions that may affect long-term morbidity and mortality.