ED Diagnosis and Treatment

There are a lot of different causes of ED/impotence in men so the treatment will vary according to the cause.

Here we’ll look at how ED is diagnosed and the different forms of treatment.

It’s often difficult talking about this intimate area of your life, and answering very personal questions. But remember that the doctor has seen and heard it before and wants to help you get to the bottom of the problem. And s/he knows it takes a lot of courage to ask for help.

Diagnosing ED.

To investigate the cause your doctor will ask you some questions and run some tests. An outline of some of this detective work might look like this:

• Because stress is a common cause of impotence, your doctor might ask about stressors (work, relationships, family pressures etc) that you’re currently under.
• You might be asked about your sexual history to see if there are (or have been) any problems with sexual desire, erection, ejaculation or orgasm.
• S/he’ll look at your medical history to see if there is any surgery/injury/disease that might cause impotence. In addition you’ll be asked about your medications/drugs (prescribed and recreational), alcohol, weight and lifestyle.
• You may have a physical examination which might give some answers – looking at your body generally can give an experienced doctor many clues to your health. S/he may check your blood pressure and look at your ankles for swelling and their pulses which might indicate a circulation problem. And s/he may look at the penis.
• Lab tests might include blood and urine looking for systemic disease or imbalance.
• Other tests include monitoring for your normal night time erections which can rule in (or rule out) some psychological causes of impotence. There is no standardised test for this.

After any general lifestyle advice about drinking, smoking, drug taking weight loss and exercise that might be needed, and changing any prescription drugs that might be causing the problem, treatment for ED is varied.

Psychotherapy and behaviour modification might be helpful if the doctor has established that this is the cause of the problem. It’s not as simple as popping a pill but is much longer lasting, effective and gives you back the control over your body. Your partner may be asked or able to help and you may be given exercises to try at home together.

Drug therapy for treating impotence can be by tablet, injection into the penis or inserted into the tip of the penis.

Oral medications include sildenafil (Viagra), vardenafil (Levitra) and tadalafil (Cialis). They belong to a class of drug called PDE inhibitors and work by enhancing the effect of a chemical that relaxes smooth muscle in the penis and increases the blood flow into it during stimulation. Therefore they improve the response to sexual stimulation.

These are taken about an hour before sexual activity and they shouldn’t be taken more than once a day, by men on some cardiac medications and those taking some drugs used to treat prostate enlargement should avoid them.

Side effects include flushing, headache, heartburn, dizziness, diarrhoea and nasal congestion.

If low testosterone levels are diagnosed then testosterone treatments are available.

Injectable medications will trigger an automatic (therefore guaranteed) erection after they’re used and many men find that they have stronger erections.

Examples of injectable treatments for impotence include papaverine hydrochloride, phentolamine, and alprostadil (Caverject) and they work by widening the blood vessels.

Side effects include scaring of the penis and persistent erection (priaprism).

A pellet of alprostadil (MUSE) can be inserted into the urethra about 10 minutes before sexual intercourse and will last 30-60 minutes.

Side effects include aching in the penis and testicles, a warm burning sensation in the urethra, minor bleeding from the urethra.

Vacuum devices cause an erection by creating a partial vacuum which then draws the blood into the penis’s spongy tissue.

They have a plastic cylinder, an elastic ring which is moved onto the base of the penis when the cylinder is removed, prevents the blood from flowing out of the penis. This ring can remain in place for about 30 minutes during intercourse.

Like the injections, this takes some time and practice, and some patience for both partners.

Side effects include the penis feeling bruised, it may feel numb or cold but users report that the pleasure of orgasm isn’t not usually affected.

Surgery for ED aims to implant a device that enables to cause the penis to become erect or to reconstruct arteries that will increase the blood flow to the penis or the block off the veins that allow the blood to leak from the penile tissue.

Inflatable implants are made up of paired cylinders which are inserted into the penis and can be expanded when the patient presses on a small pump which is located under the skin in the scrotum.

Possible problems include breakdown of the device and infection.

Surgical repair of the arteries that allow the blood into the penis, causing an erection, is most successful in younger men with a limited and identifiable blockage. In older men with more widespread blockages, the procedure is less successful.

Surgery to the veins and therefore reducing the outflow of blood from the penis is performed by skilled surgeons (as with all the other procedures) but some question its long term effectiveness.