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Erectile Dysfunction: Diagnosis and Treatment
Diagnosis
- The evaluation begins with a medical history and a physical examination.
A careful medical and sexual history is essential for diagnosis.
Sexual history should include onset of symptoms, ability to achieve
spontaneous erections (i.e., morning erections), and risk factors
for impotence (e.g., cigarette smoking, diabetes mellitus, hypertension,
drug abuse, and obesity). A psychiatric interview and questionnaire
may reveal psychological factors, such as depression and anxiety.
In some cases, it may be helpful to interview the patient’s
sexual partner.
- Blood tests may be necessary, including cholesterol level, thyroid
tests, and testosterone level.
- In some cases, overnight testing (nocturnal penile tumescence
testing) can be used to measure the number and strength of erections
during sleep, which can rule out psychological causes and can
help identify men who might benefit from corrective surgery.
- In addition, ultrasound or other tests of the penile arteries
may be recommended.
Treatment
Treatment is aimed at restoring
the capacity to acquire and sustain erections and reactivating
sexual desire.
- Smoking cessation is important if the patient smokes.
- The most commonly used medications are the phosphodiesterase–5
inhibitors (e.g., sildenafil (Viagra), vardenafil (Levitra),
and tadalafil (Cialis)). However, these medications should
not be used in men taking nitrate medications for heart disease.
- Hormonal therapy with testosterone may be effective, but
long–term use carries risks, so it is only used in a small
number of individuals with documented medical disorders.
- Treatment of associated psychiatric disorders may improve
sexual functioning. Between 20 and 50 percent of men with
impotence have symptoms of depression, which may contribute
to ED. Self–esteem may also suffer as a result. Individual
or couples psychotherapy may be a helpful part of treatment.
- In some cases, penile injections, vacuum devices, or surgery
may be beneficial.
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